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General NPI Number Information
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NPI Number | 1518125608
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Entity Type | Organization
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Legal Business Name | KENNETH W DISTLER MD PC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 2130 MARSHALL CT
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City | SAGINAW
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State | MI
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Zip | 48602-3351
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Country | US
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Telephone | 989-799-0600
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Fax | 989-799-6080
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Provider Business Mailing Address
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Address Line | 2130 MARSHALL CT
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City | SAGINAW
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State | MI
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Zip | 48602-3351
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Country | US
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Telephone | 989-799-0600
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Fax | 989-799-6080
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH W DISTLER
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Credential | MD
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Telephone | 989-799-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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