Provider Demographics
NPI:1235940974
Name:KERIAN, MICHAEL ANTHONY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:KERIAN
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 1:15109 63RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINTO
Mailing Address - State:ND
Mailing Address - Zip Code:58261-9438
Mailing Address - Country:US
Mailing Address - Phone:701-360-0456
Mailing Address - Fax:
Practice Address - Street 1:15109 63RD ST NE
Practice Address - Street 2:
Practice Address - City:MINTO
Practice Address - State:ND
Practice Address - Zip Code:58261-9438
Practice Address - Country:US
Practice Address - Phone:701-360-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care