Basic Information
| Provider Information | |||||||||
| NPI: | 1184750796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRMAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4505 NW FIELDING RD | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666182651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852700080 | ||||||||
| FaxNumber: | 7852700001 | ||||||||
| Practice Location | |||||||||
| Address1: | 4505 NW FIELDING RD | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666182651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852700080 | ||||||||
| FaxNumber: | 7852700001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2005019460 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-32359 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 068002254 | 01 | KS | MEDICARE PTAN | OTHER | 200427120C | 05 | KS | MEDICAID |