Provider Demographics
NPI:1619937315
Name:KUHNLEIN, JEROME L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:L
Last Name:KUHNLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-985-1000
Mailing Address - Fax:269-983-1627
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9159
Practice Address - Country:US
Practice Address - Phone:269-985-1000
Practice Address - Fax:269-983-1627
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430148716207RC0000X
MI4301048716207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4176450Medicaid
MI383513843OtherTAX ID
MI4176450Medicaid
MI383513843OtherTAX ID
MIC65739Medicare UPIN