Healthcare Provider Details

I. General information

NPI: 1922051275
Provider Name (Legal Business Name): KEVIN M KERNEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY ST
EVANSVILLE IN
47710-1658
US

IV. Provider business mailing address

PO BOX 3024
EVANSVILLE IN
47730-3024
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-3344
  • Fax:
Mailing address:
  • Phone: 812-471-1591
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number01059271A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: