Active NPI
Dennis A Herzog, M.D.
- Dermatology Physician
- Marquette, MI
National Provider Identifier
1700836855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 4301035261
- Practice address
- 1414 W Fair Ave
Suite 240
Marquette, MI 49855-2675 - Phone
- (906) 225-3970
- NPI assigned
- May 11, 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301035261 | MI | Primary |
Addresses
Primary practice location
1414 W Fair Ave
Suite 240
Marquette, MI 49855-2675
Mailing address
1414 W Fair Ave
Suite 240
Marquette, MI 49855-2675
Phone (906) 225-3970
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0705200122 | Other | MI | BLUE CROSS BLUE SHIELD MI |
| 101658376 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1700836855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 W FAIR AVE",
"address_2": "SUITE 240",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498552675",
"telephone_number": "906-225-3970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 W FAIR AVE",
"address_2": "SUITE 240",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498552675",
"telephone_number": "906-225-3970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERZOG",
"first_name": "DENNIS",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "4301035261",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MI",
"identifier": "0705200122",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101658376",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marquette, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.