Healthcare Provider Details

I. General information

NPI: 1487079943
Provider Name (Legal Business Name): LOWELL GISEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 S SAGINAW RD
MIDLAND MI
48640-5633
US

IV. Provider business mailing address

612 WILSON DR
MIDLAND MI
48642-3038
US

V. Phone/Fax

Practice location:
  • Phone: 989-835-4041
  • Fax:
Mailing address:
  • Phone: 989-600-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: