Healthcare Provider Details

I. General information

NPI: 1649537366
Provider Name (Legal Business Name): EMILY KERN STERN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY KERN M.D.

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9145 SPRINGBROOK DR NW STE 200
COON RAPIDS MN
55433
US

IV. Provider business mailing address

3001 BROADWAY ST NE STE 500
MINNEAPOLIS MN
55413-2197
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1145
  • Fax: 612-870-5491
Mailing address:
  • Phone: 612-871-1145
  • Fax: 612-870-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number63399
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036-137169
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-137169
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125061061
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: