MEDICARE: JEFFREY S HERMAN 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	2085R0001X	Radiation Oncology Physician	35203	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2D631HE	OTHER	MN	BLUE CROSS/BLUE SHIELD
2	HP13510	OTHER	MN	HEALTH PARTNERS
3	2400004	OTHER	MN	MEDICA PRIMARY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	110584	OTHER	MN	CHOICE PLUS
6	25133	OTHER	MN	AMERICA'S PPO
7	104838	OTHER	MN	UCARE
8	2424221	OTHER	MN	MEDICA
9	963070250011	OTHER	MN	PREFERRED ONE

General Provider Information

NPI Number	:	1689666497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY S HERMAN MD

Provider Business Mailing Address
First Line	:	6950 FRANCE AVE S
Second Line	:	MPLS RADIATION ONCOLOGY
City	:	EDINA
State	:	MN
Zip	:	55435-2025
Country	:	US
Telephone Number	:	952-920-4915
Fax Number	:	952-915-6091

Provider Business Practice Location Address
First Line	:	550 OSBORNE RD NE
Second Line	:	UNITY RADIATION THERAPY CTR
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-784-1182
Fax Number	:	763-784-1637

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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