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General NPI Number Information
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NPI Number | 1114640273
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Entity Type | Organization
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Legal Business Name | INTEGRATED HOME DOCTORS P.L.L.C.
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 11670 MARTIN RD STE 102
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City | WARREN
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State | MI
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Zip | 48093-4511
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Country | US
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Telephone | 734-904-1016
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Fax |
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Provider Business Mailing Address
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Address Line | 11670 MARTIN RD STE 102
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City | WARREN
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State | MI
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Zip | 48093-4511
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Country | US
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Telephone | 734-904-1016
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD LEE KISSEL
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Credential | M.D.
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Telephone | 847-431-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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