Healthcare Provider Details

I. General information

NPI: 1083067227
Provider Name (Legal Business Name): NATHAN DAVID KERN AUD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 E BROOMFIELD ST
MT PLEASANT MI
48858-4449
US

IV. Provider business mailing address

1290 E BROOMFIELD ST
MT PLEASANT MI
48858-4449
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-1209
  • Fax: 989-773-4267
Mailing address:
  • Phone: 989-773-1209
  • Fax: 989-773-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000749
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: