Basic Information
| Provider Information | |||||||||
| NPI: | 1588667596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JERMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RAMSEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10238 E HAMPTON AVE STE 501 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852093321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808891573 | ||||||||
| FaxNumber: | 4808891574 | ||||||||
| Practice Location | |||||||||
| Address1: | 10238 E HAMPTON AVE STE 501 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852093321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808891573 | ||||||||
| FaxNumber: | 4808891574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 17678 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 17678 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 5014510 | 01 | AZ | CCN | OTHER | 10076433 | 01 | AZ | PPO NEXT | OTHER | 1Z2507 | 01 | AZ | HEALTH NET | OTHER | 278433 | 05 | AZ | MEDICAID | 100665 | 01 | AZ | ONE HEALTH | OTHER | 7952545 | 01 | AZ | GHI | OTHER | 005502301 | 01 | AZ | CIGNA | OTHER | 3503 | 01 | AZ | ARIZONA MEDICAL NETWORK | OTHER | 22663 | 01 | AZ | PREFERRED HEALTH NETWORK | OTHER | 4062282 | 01 | AZ | AETNA | OTHER | 52415 | 01 | AZ | FIRST HEALTH | OTHER | 060057127 | 01 | AZ | RAILROAD MEDICARE | OTHER | AZ0860290 | 01 | AZ | BCBS OF ARIZONA | OTHER |