Healthcare Provider Details

I. General information

NPI: 1164587242
Provider Name (Legal Business Name): CATHERINE HEROD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FAIRGROUNDS RD
TIPTON IN
46072-9596
US

IV. Provider business mailing address

800 FULTON ST C/O ANNE LAWSON
LOGANSPORT IN
46947-1577
US

V. Phone/Fax

Practice location:
  • Phone: 765-408-0536
  • Fax: 765-408-0539
Mailing address:
  • Phone: 574-205-2600
  • Fax: 574-739-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01036845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: