Provider Demographics
NPI:1730386186
Name:HERDZIK, MONIKA ANNA (MD)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:ANNA
Last Name:HERDZIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:ANNA
Other - Last Name:KUCHARZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4401 N CAMPUS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6112
Mailing Address - Country:US
Mailing Address - Phone:989-837-9300
Mailing Address - Fax:989-837-9307
Practice Address - Street 1:4401 CAMPUS RIDGE DR STE 2100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6125
Practice Address - Country:US
Practice Address - Phone:989-837-9300
Practice Address - Fax:989-837-9307
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301090375OtherST. MEDICAL LICENSE