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General NPI Number Information
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NPI Number | 1013001221
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Entity Type | Organization
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Legal Business Name | CHARLES G KISSEL DPM PC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 29433 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-2203
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Country | US
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Telephone | 586-574-0500
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Fax | 586-574-2694
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Provider Business Mailing Address
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Address Line | 29433 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-2203
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Country | US
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Telephone | 586-574-0500
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Fax | 586-574-2694
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Authorized Official
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Title or Position | MANAGER
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Name | CINDY SMITH
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Credential |
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Telephone | 586-574-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | CK000960
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | MS00843
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | CK000960
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | ZH002007
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License Number State | MI
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