Provider Demographics
NPI:1508955675
Name:KERNIS, IRVING D (DO)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:D
Last Name:KERNIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 TREYBORNE CIR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2832
Mailing Address - Country:US
Mailing Address - Phone:248-684-5510
Mailing Address - Fax:
Practice Address - Street 1:2632 S. MILFORD RD
Practice Address - Street 2:HURON VALLEY PEDIATRICS, P.C.
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357
Practice Address - Country:US
Practice Address - Phone:248-684-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010061472080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4108639Medicaid
MI4108639Medicaid