Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101015002 | MI |
NPI | 1003859299 |
---|---|
Provider Name | Kristi Kern |
First Address | Wyoming, MI 49519-9606 |
Second Address | Grand Rapids, MI 49546-3631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 05/12/2017 |