Healthcare Provider Details

I. General information

NPI: 1508955675
Provider Name (Legal Business Name): IRVING D KERNIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 S. MILFORD RD HURON VALLEY PEDIATRICS, P.C.
HIGHLAND MI
48357
US

IV. Provider business mailing address

1675 TREYBORNE CIR
COMMERCE TOWNSHIP MI
48390-2832
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-5510
  • Fax:
Mailing address:
  • Phone: 248-684-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5101006147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: