Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01058161A | IN |
NPI | 1063522654 |
---|---|
Provider Name | Kenneth Herrmann |
First Address | Newburgh, IN 47630-8940 |
Second Address | Newburgh, IN 47630-8940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01058161 | LICENSE (01) | IN |
200455380 | (05) | IN |
64073281 | (05) | KY |
C97431 | (02) |