Basic Information
| Provider Information | |||||||||
| NPI: | 1598750986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475911038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128853344 | ||||||||
| FaxNumber: | 8128853811 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475911038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128853344 | ||||||||
| FaxNumber: | 8128853811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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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 | 207P00000X | 01057599A | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 003230 | 01 | IL | HEALTH ALLIANCE | OTHER | 036107791 | 05 | IL | MEDICAID | 624302 | 01 | IL | HEALTHLINK | OTHER | 200450570 | 05 | IN | MEDICAID | 2168888 | 01 | IL | UNITED HEALTHCARE | OTHER | 5132004 | 01 | IL | BLUECROSS BLUESHIELD | OTHER | 1729885 | 01 | IL | FIRST HEALTH | OTHER |