Provider Demographics
NPI:1093771412
Name:KERN, LYNN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:JAMES
Last Name:KERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HEALTH PKWY
Mailing Address - Street 2:BOX 89
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8242
Mailing Address - Country:US
Mailing Address - Phone:269-655-3070
Mailing Address - Fax:269-655-0767
Practice Address - Street 1:451 HEALTH PKWY
Practice Address - Street 2:BOX 89
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8242
Practice Address - Country:US
Practice Address - Phone:269-655-3070
Practice Address - Fax:269-655-0767
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101705206Medicaid
MI4301036731OtherMEDICAL LICENSE
MI2919468Medicaid
MI2919468Medicaid
MIAK7135812OtherDEA NUMBER
MIM20520075Medicare PIN
MI4301036731OtherMEDICAL LICENSE
MI101705206Medicaid