NPIMap

Organization Active NPI

Dennis a. Herzog, M.D.,P.C

  • Dermatology Physician
  • Marquette, MI
National Provider Identifier
1831231083
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301035261 Issued in MI
Legal business name
DENNIS A. HERZOG, M.D.,P.C
Practice address
1414 W Fair Ave Ste 240
Marquette, MI 49855-5409
Phone
(906) 225-3970
NPI assigned
Feb 13, 2007
Last updated
May 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dennis A. Herzog, M.D.NPI 1700836855
Title
Owner
Phone
(906) 225-3970

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 4301035261 MI Primary

Addresses

Primary practice location

1414 W Fair Ave Ste 240
Marquette, MI 49855-5409

Mailing address

1414 W Fair Ave Ste 240
Marquette, MI 49855-5409
Phone (906) 225-3970

Other identifiers 2

IdentifierTypeStateIssuer
101658376MedicaidMI
0705200122OtherMIBLUE CROSS BLUE SHIELD MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1831231083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 240",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555409",
            "telephone_number": "906-225-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 240",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555409",
            "telephone_number": "906-225-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENNIS A. HERZOG, M.D.,P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "906-225-3970",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301035261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101658376",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "0705200122",
            "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.

Verify at the official NPI Registry.