Provider Demographics
NPI:1417281510
Name:HERD, COLIN CAMPBELL (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:CAMPBELL
Last Name:HERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 FELCH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464
Mailing Address - Country:US
Mailing Address - Phone:616-748-2850
Mailing Address - Fax:616-748-2855
Practice Address - Street 1:8333 FELCH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464
Practice Address - Country:US
Practice Address - Phone:616-748-2850
Practice Address - Fax:616-748-2855
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI089203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM56180024Medicare PIN