Healthcare Provider Details

I. General information

NPI: 1174625313
Provider Name (Legal Business Name): MICHAEL E HERRMANN MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 966 2900 FRANK SCOTT PKWY W
BELLEVILLE IL
62223-5000
US

IV. Provider business mailing address

SUITE 966 2900 FRANK SCOTT PKWY W
BELLEVILLE IL
62223-5000
US

V. Phone/Fax

Practice location:
  • Phone: 618-235-8600
  • Fax: 618-235-8869
Mailing address:
  • Phone: 618-235-8600
  • Fax: 618-235-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL E HERRMANN
Title or Position: PRESIDENT
Credential: MD
Phone: 618-235-8600