MEDICARE: JOSHUA C KERSHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	217393	MA

General Provider Information

NPI Number	:	1770521064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA C KERSHEN M.D.

Provider Business Mailing Address
First Line	:	4221 S WESTERN AVE
Second Line	:	5000
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3447
Country	:	US
Telephone Number	:	405-644-5160
Fax Number	:	405-644-5162

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE
Second Line	:	5000
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3447
Country	:	US
Telephone Number	:	405-644-5165
Fax Number	:	405-644-6668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/22/2015

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