Provider Demographics
NPI:1750060307
Name:KERSSE, YOSEF DEGU
Entity type:Individual
Prefix:
First Name:YOSEF
Middle Name:DEGU
Last Name:KERSSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 LEUMAS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7605
Mailing Address - Country:US
Mailing Address - Phone:513-592-8579
Mailing Address - Fax:
Practice Address - Street 1:5421 LEUMAS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7605
Practice Address - Country:US
Practice Address - Phone:513-592-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTJ761046172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver