MEDICARE: BENJAMIN JOSEPH HERMANN

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	2471C3401X	Computed Tomography Radiologic Technologist
2	2471C3402X	Radiography Radiologic Technologist	XT022434	IN

General Provider Information

NPI Number	:	1447666011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JOSEPH HERMANN

Provider Business Mailing Address
First Line	:	10 ANDREA CT
Second Line	:
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-2604
Country	:	US
Telephone Number	:	317-727-1401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1481 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2803
Country	:	US
Telephone Number	:	317-988-2528
Fax Number	:

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	07/03/2014

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Directions to “ BENJAMIN JOSEPH HERMANN ” Practice Location

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