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Individual
RUSSELL KERSCHMANN
Active
Individual
RUSSELL KERSCHMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A57159
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BJ422Y
MEDICARE PTAN
CA
01
—
G57159
CA STATE LICENSE
CA
Enumeration date
11/15/2006
Last updated
05/13/2009
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