Basic Information
| Provider Information | |||||||||
| NPI: | 1174742472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERTZFELD | ||||||||
| FirstName: | KARA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE STE 800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851992 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Practice Location | |||||||||
| Address1: | 5805 MONCLOVA RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241952 | ||||||||
| FaxNumber: | 4198240344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 4301097412 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 35095467 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1174742472 | 01 | MI | MI MEDICAID-OH LOCATIONS | OTHER | 3085889 | 05 | OH | MEDICAID | 1174742472 | 05 | MI | MEDICAID | P00900979 | 01 | OH | RR MEDICARE | OTHER |