Healthcare Provider Details

I. General information

NPI: 1457055329
Provider Name (Legal Business Name): MICHAEL HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 OAKTON ST
PARK RIDGE IL
60068-1958
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 847-993-8020
  • Fax: 847-993-8018
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160009780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: