MEDICARE: DR. JAMES R HERRON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036047483	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174555361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R HERRON MD

Provider Business Mailing Address
First Line	:	4008 CHESTER DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1047
Country	:	US
Telephone Number	:	312-291-9083
Fax Number	:	312-624-9183

Provider Business Practice Location Address
First Line	:	1030 N CLARK ST
Second Line	:	STE 647
City	:	CHICAGO
State	:	IL
Zip	:	60610-5467
Country	:	US
Telephone Number	:	312-291-9083
Fax Number	:	312-624-9183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/19/2011

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