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General NPI Number Information
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NPI Number | 1043498652
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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 | 02/06/2008
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Last Update Date | 05/16/2008
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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 | PARTNER
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Name | CHARLES G KISSEL
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Credential | DPM
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | CK000960
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License Number State | MI
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