Healthcare Provider Details

I. General information

NPI: 1720080351
Provider Name (Legal Business Name): ROBERT C KISER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ROBERT JONES WAY
KALAMAZOO MI
49009-1904
US

IV. Provider business mailing address

2520 ROBERT JONES WAY
KALAMAZOO MI
49009-1904
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-0400
  • Fax:
Mailing address:
  • Phone: 269-375-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101012110
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number5101012110
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012110
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: