Provider Demographics
NPI:1568495406
Name:KERR, CHARLES E (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:KERR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:801 JOE MANN BLVD STE P-6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8900
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:1601 MARQUETTE ST
Practice Address - Street 2:STE 6
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4196
Practice Address - Country:US
Practice Address - Phone:989-667-0561
Practice Address - Fax:989-667-0567
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0007246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIZ96017024OtherMEDICARE PTAN
MI1791213Medicaid
MIB44260Medicare UPIN
MI5090004Medicare PIN