Provider Demographics
NPI:1376512863
Name:KERNER, GENISE EILENDER (MD)
Entity Type:Individual
Prefix:
First Name:GENISE
Middle Name:EILENDER
Last Name:KERNER
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 1:29275 NORTHWESTERN HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5744
Mailing Address - Country:US
Mailing Address - Phone:248-996-8332
Mailing Address - Fax:734-779-5050
Practice Address - Street 1:29275 NORTHWESTERN HWY STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5744
Practice Address - Country:US
Practice Address - Phone:248-996-8332
Practice Address - Fax:734-779-5050
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376512863Medicaid
MIMI4989501Medicare PIN
MI1376512863Medicaid