Provider Demographics
NPI:1730295130
Name:KERMAN, BRIAN L (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:KERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27031 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3401
Mailing Address - Country:US
Mailing Address - Phone:248-545-4888
Mailing Address - Fax:248-545-4327
Practice Address - Street 1:27031 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3401
Practice Address - Country:US
Practice Address - Phone:248-545-4888
Practice Address - Fax:248-545-4327
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK000547213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1008068Medicaid
MI1008068Medicaid
MI5635191Medicare PIN