Provider Demographics
NPI:1902804966
Name:HERMAN, MICHELLE ANN (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46325 W. TWELVE MILE ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-465-1200
Mailing Address - Fax:248-465-2850
Practice Address - Street 1:46325 W. TWELVE MILE ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-465-1200
Practice Address - Fax:248-465-2850
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013784207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI456067711Medicaid
MIH85451Medicare UPIN