Provider Demographics
NPI:1306653860
Name:HERRIN, KURT BRUCE
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:BRUCE
Last Name:HERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 W 148TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3138
Mailing Address - Country:US
Mailing Address - Phone:216-906-9126
Mailing Address - Fax:
Practice Address - Street 1:3675 W 148TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3138
Practice Address - Country:US
Practice Address - Phone:216-906-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program