Provider Demographics
NPI:1992807358
Name:HERMAN, JEFFREY S (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N MILFORD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1032
Mailing Address - Country:US
Mailing Address - Phone:248-685-9780
Mailing Address - Fax:248-684-2251
Practice Address - Street 1:1435 N MILFORD RD
Practice Address - Street 2:STE 101
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1032
Practice Address - Country:US
Practice Address - Phone:248-685-9780
Practice Address - Fax:248-684-2251
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH009628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2802124Medicaid
MIB6841OtherMCARE
110053841OtherRR MEDICARE
OF37286002Medicare ID - Type UnspecifiedINDIVIDUAL
110053841OtherRR MEDICARE
F02030Medicare UPIN