Healthcare Provider Details

I. General information

NPI: 1588734842
Provider Name (Legal Business Name): CHRISTOPHER M HERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

PO BOX 75478
BALTIMORE MD
21275-5478
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-5000
  • Fax: 904-346-0113
Mailing address:
  • Phone: 866-402-4367
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036115549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: