Provider Demographics
NPI:1346281144
Name:KERN, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KERN
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 1:16226 MADEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4890
Mailing Address - Country:US
Mailing Address - Phone:281-225-9461
Mailing Address - Fax:
Practice Address - Street 1:5200 MITCHELLDALE
Practice Address - Street 2:SUITE E16
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7222
Practice Address - Country:US
Practice Address - Phone:281-956-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE27222Medicare UPIN
TX00DW57Medicare PIN