Provider Demographics
NPI:1083852917
Name:KERSHAW, MARTHA O (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:O
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2217
Mailing Address - Country:US
Mailing Address - Phone:734-663-5957
Mailing Address - Fax:
Practice Address - Street 1:103 ARNET ST.
Practice Address - Street 2:HOPE MEDICAL CLINIC
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198
Practice Address - Country:US
Practice Address - Phone:734-481-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine