MEDICARE: KURT BRUCE HERRIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.009839RX	OH

General Provider Information

NPI Number	:	1306653860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT BRUCE HERRIN

Provider Business Mailing Address
First Line	:	3675 W 148TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3138
Country	:	US
Telephone Number	:	216-906-9126
Fax Number	:

Provider Business Practice Location Address
First Line	:	3675 W 148TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3138
Country	:	US
Telephone Number	:	216-906-9126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	10/17/2025

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Directions to “ KURT BRUCE HERRIN ” Practice Location

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