Healthcare Provider Details

I. General information

NPI: 1902075054
Provider Name (Legal Business Name): SAMUEL C KERNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 AUBURN ROAD #103
PAINESVILLE OH
44077
US

IV. Provider business mailing address

7580 AUBURN ROAD #103
PAINESVILLE OH
44077
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-1474
  • Fax: 440-352-2662
Mailing address:
  • Phone: 440-352-1474
  • Fax: 440-352-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-091099
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-091099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: