Individual
DENNIS A HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 W FAIR AVE, SUITE 240, MARQUETTE, MI 49855-2675
(906) 225-3970
Mailing address
1414 W FAIR AVE, SUITE 240, MARQUETTE, MI 49855-2675
(906) 225-3970
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301035261
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0705200122
BLUE CROSS BLUE SHIELD MI
MI
05
—
101658376
—
MI
Enumeration date
05/11/2006
Last updated
05/20/2008
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