Healthcare Provider Details

I. General information

NPI: 1407940190
Provider Name (Legal Business Name): BRIAN JAMES KERR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 W ROYAL DR
TRAVERSE CITY MI
49684-8965
US

IV. Provider business mailing address

4045 W ROYAL DR
TRAVERSE CITY MI
49684-8965
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-0900
  • Fax: 231-935-0308
Mailing address:
  • Phone: 231-935-0900
  • Fax: 231-935-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301089821
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: