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General NPI Number Information
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NPI Number | 1467929927
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Entity Type | Individual
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Provider Name | KEVIN LOUIS CISCHKE NP
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Gender | Male
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 313-576-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 6145 HIDDENBROOK DR
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City | TOLEDO
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State | OH
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Zip | 43613-1522
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Country | US
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Telephone | 734-755-2728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN.416348
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.023948
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704341344
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License Number State | MI
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