Provider Demographics
NPI:1902932924
Name:HERTZBERG, NEIL (DPM)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:HERTZBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6689 ORCHARD LAKE RD STE 275
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3404
Mailing Address - Country:US
Mailing Address - Phone:248-569-9920
Mailing Address - Fax:248-788-0455
Practice Address - Street 1:5028 VILLAGE SQUARE CIRCLE
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-569-9920
Practice Address - Fax:248-788-0455
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000838213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery