Provider Demographics
NPI:1992760979
Name:KERNEN, KENNETH M (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:KERNEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:130 TOWN CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1744
Practice Address - Country:US
Practice Address - Phone:248-740-0670
Practice Address - Fax:248-740-0668
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-07-28
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Provider Licenses
StateLicense IDTaxonomies
MI4301062269208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH13405OtherHAP
MI129721OtherPRIORITY HEALTH
MI0994918OtherHEALTH PLUS
MI2161865002OtherCIGNA
MI7275202OtherAETNA
MI340017619OtherRAILROAD MEDICARE
MI7275202OtherAETNA
MIH13405Medicare UPIN
MI0E06273022Medicare PIN