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General NPI Number Information
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NPI Number | 1083852917
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Entity Type | Individual
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Provider Name | MARTHA O. KERSHAW M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 103 ARNET ST. HOPE MEDICAL CLINIC
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City | YPSILANTI
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State | MI
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Zip | 48198
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Country | US
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Telephone | 734-481-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 2785 DANBURY LN
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City | ANN ARBOR
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State | MI
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Zip | 48103-2217
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Country | US
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Telephone | 734-663-5957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301057426
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License Number State | MI
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