Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | GK075761 | MI |
NPI | 1013900190 |
---|---|
Provider Name | Glenn Evan Kershen |
First Address | Saginaw, MI 48601-2558 |
Second Address | Saginaw, MI 48601-2558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0987964 | HEALTHPLUS (01) | MI |
340020605 | RAILROAD MEDICARE (01) | MI |
340G310500 | BLUE CROSS (01) | MI |
4433790 | (05) | MI |
7792123 | AETNA (01) | MI |
H11966 | (02) | MI |
H11966 | TRI CARE (01) | MI |