MEDICARE: CHRISTOPHER EMIL HERMANN NP-C

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	363LA2200X	Adult Health Nurse Practitioner	4704128568	MI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356344121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER EMIL HERMANN NP-C

Provider Business Mailing Address
First Line	:	6592 N SILVERY LN
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2170
Country	:	US
Telephone Number	:	313-274-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6592 N SILVERY LN
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2170
Country	:	US
Telephone Number	:	313-316-4236
Fax Number	:	313-262-1927

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/16/2021

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