Provider Demographics
NPI:1972006047
Name:GENISE KERNER MD PC
Entity Type:Organization
Organization Name:GENISE KERNER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-836-8129
Mailing Address - Street 1:7969 FARRANT ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2320
Mailing Address - Country:US
Mailing Address - Phone:248-836-8129
Mailing Address - Fax:734-779-1001
Practice Address - Street 1:37675 PEMBROOKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-779-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045002261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376512863OtherINT MED