MEDICARE: NEIL F HERTZBERG DPM

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	213E00000X	Podiatrist	NH000838	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4886350160	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841470291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIL F HERTZBERG DPM

Provider Business Mailing Address
First Line	:	6689 ORCHARD LAKE RD STE 275
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3404
Country	:	US
Telephone Number	:	248-569-9920
Fax Number	:	248-569-9921

Provider Business Practice Location Address
First Line	:	5028 VILLAGE SQUARE CIRCLE
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322
Country	:	US
Telephone Number	:	248-569-9920
Fax Number	:	248-788-0455

Authorized Official
Title or Position	:	OWNER/PODIATRIST
Name	:	NEIL FARREL HERTZBERG
Credential	:	DPM
Telephone Number	:	248-569-9920

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	05/25/2021

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Directions to “NEIL F HERTZBERG DPM ” Practice Location

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