1295775500 NPI number — CATHERINE L. HERZOG PH.D.

Table of content: CATHERINE L. HERZOG PH.D. (NPI 1295775500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295775500 NPI number — CATHERINE L. HERZOG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERZOG
Provider First Name:
CATHERINE
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295775500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1370 N OAKLAND BLVD
Provider Second Line Business Mailing Address:
SUITE 100A
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48327-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-886-1371
Provider Business Mailing Address Fax Number:
248-886-1372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1370 N OAKLAND
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48327-4525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-886-1371
Provider Business Practice Location Address Fax Number:
248-886-1372
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6301008327 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com