Active NPI
Michael Joseph Herriges, D.D.S.
- General Practice Dentistry
- Great Lakes, IL
National Provider Identifier
1295714616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19020040
- Practice address
- 3001 A Sixth St
Great Lakes, IL 60088-5230 - Phone
- (847) 688-2100
- NPI assigned
- Jan 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 19020040 | IL | Primary |
Addresses
Primary practice location
3001 A Sixth St
Great Lakes, IL 60088-5230
Mailing address
420 Middlebury Dr
Lake Villa, IL 60046-5077
Phone (847) 265-0898
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19020040 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282780800000",
"number": "1295714616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 MIDDLEBURY DR",
"city": "LAKE VILLA",
"state": "IL",
"postal_code": "600465077",
"telephone_number": "847-265-0898",
"fax_number": "847-265-1193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 A SIXTH ST",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600885230",
"telephone_number": "847-688-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRIGES",
"first_name": "MICHAEL",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-13",
"last_updated": "2010-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "19020040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.