Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 01066402A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01066402A | IN |
NPI | 1184881641 |
---|---|
Provider Name | Jeremy Herrmann |
First Address | Cincinnati, OH 45263-6762 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
074790020 | (02) | IN |