Healthcare Provider Details

I. General information

NPI: 1255313052
Provider Name (Legal Business Name): J. PAUL KERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S ROGERS ST
BLOOMINGTON IN
47403-2335
US

IV. Provider business mailing address

7950 N SHADELAND AVE SUITE 100
INDIANAPOLIS IN
46250-2691
US

V. Phone/Fax

Practice location:
  • Phone: 812-337-0700
  • Fax: 812-337-0714
Mailing address:
  • Phone: 317-588-7130
  • Fax: 317-588-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01037233A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: