MEDICARE: DR. KATHERINE ELIZABETH HERZOG M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	P7647	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	2013027011	MO

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	:	1356504385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE ELIZABETH HERZOG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 74008272
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-8272
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	14855 N OUTER 40 RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2026
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	10/03/2025

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