Provider Demographics
NPI:1316910649
Name:HERN, ANN E (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:E
Last Name:HERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:230 W MAPLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5435
Mailing Address - Country:US
Mailing Address - Phone:248-362-3500
Mailing Address - Fax:248-362-1941
Practice Address - Street 1:230 W MAPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5435
Practice Address - Country:US
Practice Address - Phone:248-362-3500
Practice Address - Fax:248-362-1941
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052754207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F28205Medicare UPIN
N48440002Medicare ID - Type Unspecified