Provider Demographics
NPI:1588663363
Name:KERPSACK, JOSEPH THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:KERPSACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2031
Mailing Address - Country:US
Mailing Address - Phone:321-841-5281
Mailing Address - Fax:407-648-9879
Practice Address - Street 1:83 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2031
Practice Address - Country:US
Practice Address - Phone:321-841-5281
Practice Address - Fax:407-648-9879
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4485-K207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
341931777OtherCARELINK HEALTH PLAN
KE977924OtherHIGHMARK
000000179629OtherANTHEM
215531OtherUPMC
341931777OtherHEALTH ASSURANCE/HE
341931777BOtherAULTCARE
OH2079727Medicaid
34193177700OtherWORKERS COMP
341931777JKOtherSUMMA CARE
07-02002OtherUHC
2079727OtherWELFARE CLASS
215531OtherUPMC
OH0861612Medicare ID - Type Unspecified
341931777JKOtherSUMMA CARE
341931777OtherCARELINK HEALTH PLAN