Healthcare Provider Details

I. General information

NPI: 1033537089
Provider Name (Legal Business Name): KIMBERLY LYNN HERRMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL OF MI / SPEC CTR 3950 BEAUBIEN
DETROIT MI
48201
US

IV. Provider business mailing address

UNIVERSITY PEDIATRICIANS 4201 ST. ANTOINE UHC 5D # 226
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-8290
  • Fax:
Mailing address:
  • Phone: 313-966-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101024616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: