Provider Demographics
NPI:1841452604
Name:HERRERA, JOSE JAVIER (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:909 FEE RD
Practice Address - Street 2:ROOM B119
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-6549
Practice Address - Country:US
Practice Address - Phone:517-353-3070
Practice Address - Fax:517-432-3603
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2023-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010929452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841452604Medicaid
MI1841452604Medicaid