Individual
TYCHO E KERSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W 5TH AVE STE 400, SPOKANE, WA 99204-2715
(509) 344-2663
(509) 624-9179
Mailing address
601 W 5TH AVE, SUITE 400, SPOKANE, WA 99204-2715
(509) 344-2663
(509) 624-9179
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
MD00039855
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010135813
REGENCE BLUE SHIELD
ID
01
—
0149631
DEPT OF LABOR & INDUSTRIE
WA
01
—
200040948
RR MEDICARE
WA
01
—
22669
GROUP HEALTH NW
WA
01
—
379109600
OWCP
WA
01
—
5030KE
ASURIS NW HEALTH
WA
05
—
806017400
—
ID
05
—
8276586
—
WA
01
—
8928289
CRIME VICTIMS
WA
01
—
KQ803
BLUE CROSS OF IDAHO
ID
Enumeration date
02/28/2006
Last updated
11/20/2024
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