Healthcare Provider Details

I. General information

NPI: 1609204791
Provider Name (Legal Business Name): ELIZABETH HERMAN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 W SCHILLER ST 1601
CHICAGO IL
60610-4966
US

IV. Provider business mailing address

88 W SCHILLER ST 1601
CHICAGO IL
60610-4966
US

V. Phone/Fax

Practice location:
  • Phone: 312-878-8800
  • Fax:
Mailing address:
  • Phone: 312-878-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: