Basic Information
| Provider Information | |||||||||
| NPI: | 1437687720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMIZ | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | NAREEN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64580 VAN DYKE RD STE C | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480952811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867529629 | ||||||||
| FaxNumber: | 5867521913 | ||||||||
| Practice Location | |||||||||
| Address1: | 64580 VAN DYKE RD STE C | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480952811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867529629 | ||||||||
| FaxNumber: | 5867521913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2017 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101023214 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.