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General NPI Number Information
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NPI Number | 1447389051
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Entity Type | Organization
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Legal Business Name | DPMKISHNRSC LLC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 411 LOCKMAN RD
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City | ELGIN
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State | SC
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Zip | 29045-8715
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Country | US
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Telephone | 803-466-0504
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Fax |
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Provider Business Mailing Address
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Address Line | 411 LOCKMAN RD
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City | ELGIN
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State | SC
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Zip | 29045-8715
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Country | US
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Telephone | 803-466-0504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT N KISH
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Credential | DPM
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Telephone | 803-466-0504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 144
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License Number State | SC
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