Provider Demographics
NPI:1588734842
Name:HERMAN, CHRISTOPHER M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75478
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5478
Mailing Address - Country:US
Mailing Address - Phone:866-402-4367
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:2200 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4364
Practice Address - Country:US
Practice Address - Phone:309-661-5000
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115549207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361155491Medicaid
IL0361155494Medicaid
ILP00936469OtherRRMCARE THRU CESIISC (GES)
ILP00347340OtherRAILROAD MEDICARE
IL0361155494Medicaid
ILI64338Medicare UPIN
IL0361155491Medicaid