Organization
DENNIS A. HERZOG, M.D.,P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS A. HERZOG M.D. (OWNER)
(906) 225-3970
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE STE 240, MARQUETTE, MI 49855-5409
(906) 225-3970
Mailing address
1414 W FAIR AVE STE 240, MARQUETTE, MI 49855-5409
(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
02/13/2007
Last updated
05/20/2008
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