MEDICARE: EDWARD B. HERZIG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	35038198	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00824188	OTHER	OH	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073573218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD B. HERZIG M.D.

Provider Business Mailing Address
First Line	:	5150 SANDY LN
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2738
Country	:	US
Telephone Number	:	513-896-9595
Fax Number	:	513-896-4171

Provider Business Practice Location Address
First Line	:	5150 SANDY LN
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2738
Country	:	US
Telephone Number	:	513-896-9595
Fax Number	:	513-896-4171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/11/2011

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Directions to “ EDWARD B. HERZIG M.D.” Practice Location

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