MEDICARE: DR. MICHAEL R HERU 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	207R00000X	Internal Medicine Physician	8125	RI

Other Identifiers

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

General Provider Information

NPI Number	:	1982651626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R HERU M.D.

Provider Business Mailing Address
First Line	:	594 GREAT RD
Second Line	:	SUITE 103
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-6810
Country	:	US
Telephone Number	:	401-597-0088
Fax Number	:	401-597-0077

Provider Business Practice Location Address
First Line	:	594 GREAT RD
Second Line	:	SUITE 103
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-6810
Country	:	US
Telephone Number	:	401-597-0088
Fax Number	:	401-597-0077

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2016

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