Healthcare Provider Details

I. General information

NPI: 1568504983
Provider Name (Legal Business Name): IDRIS A HERRING MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

3800 WOODWARD AVE STE 600
DETROIT MI
48201-2061
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-7002
  • Fax: 313-993-0282
Mailing address:
  • Phone: 313-262-1303
  • Fax: 313-262-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801070264
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: