Provider Demographics
NPI:1821081464
Name:ERWIN, KERMIT R (MD)
Entity Type:Individual
Prefix:
First Name:KERMIT
Middle Name:R
Last Name:ERWIN
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 1:1250 RALSTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-5311
Mailing Address - Country:US
Mailing Address - Phone:419-782-5774
Mailing Address - Fax:419-782-6103
Practice Address - Street 1:1250 RALSTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-5311
Practice Address - Country:US
Practice Address - Phone:419-782-5774
Practice Address - Fax:419-782-6103
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH160050275OtherRRMC
OH03536OtherPHC
OH4228849OtherAETNA
OH2165688Medicaid
OH0702351OtherUHC
OH000000177993OtherANTHEM
OH2165688Medicaid
OH4228849OtherAETNA