Provider Demographics
NPI:1609827369
Name:HERMAN, BRIAN K (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1584
Mailing Address - Country:US
Mailing Address - Phone:888-727-1070
Mailing Address - Fax:866-752-2240
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:EISENHOWER IMAGING CENTER
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-340-3911
Practice Address - Fax:760-674-3852
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG768952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G768950Medicaid
CA00G768950OtherBLUE SHIELD OF CA
CA00G768950Medicaid
G87723Medicare UPIN
CA00G768952Medicare PIN