Provider Demographics
NPI:1801876164
Name:HERMAN, EUGENE KERRY (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KERRY
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:29355 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1053
Mailing Address - Country:US
Mailing Address - Phone:248-223-9650
Mailing Address - Fax:248-223-9662
Practice Address - Street 1:29355 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1053
Practice Address - Country:US
Practice Address - Phone:248-223-9650
Practice Address - Fax:248-223-9662
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIEH049218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2686562Medicaid
MI2686562Medicaid
A76582Medicare UPIN