MEDICARE: DR. KRISTEN A 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	208000000X	Pediatrics Physician	4301074131	MI

General Provider Information

NPI Number	:	1861475105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN A HERMAN MD

Provider Business Mailing Address
First Line	:	15125 22 MILE RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-4406
Country	:	US
Telephone Number	:	586-532-0599
Fax Number	:	586-566-8967

Provider Business Practice Location Address
First Line	:	75 BARCLAY CIR
Second Line	:	STE 115
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5820
Country	:	US
Telephone Number	:	248-856-6300
Fax Number	:	248-856-6303

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	03/23/2023

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