Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11016662A | IN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 02004816A | IN |
NPI | 1033470851 |
---|---|
Provider Name | Dr. Nicholas Harold Kerr |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201111540 | (05) | IN |
261970036 | (02) | IN |