Healthcare Provider Details

I. General information

NPI: 1013904671
Provider Name (Legal Business Name): HERSCHELL SERVIES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 N LEBANON ST STE 150
LEBANON IN
46052-8622
US

IV. Provider business mailing address

2705 N LEBANON ST STE 305
LEBANON IN
46052-8622
US

V. Phone/Fax

Practice location:
  • Phone: 765-485-8880
  • Fax: 765-485-8889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01026360
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01026360
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: