MEDICARE: DR. GARY RICHARD KERSTEIN D.O.

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	5101010792	MI

General Provider Information

NPI Number	:	1992903371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY RICHARD KERSTEIN D.O.

Provider Business Mailing Address
First Line	:	1800 HICKORY VALLEY RD
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-4276
Country	:	US
Telephone Number	:	248-685-3095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 HICKORY VALLEY RD
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-4276
Country	:	US
Telephone Number	:	248-685-3095
Fax Number	:

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	07/08/2007

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