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General NPI Number Information
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NPI Number | 1700863412
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Entity Type | Individual
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Provider Name | TIMOTHY DEAN KISTLER DPM
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 614 W LYTLE ST
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City | FOSTORIA
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State | OH
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Zip | 44830-3422
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Country | US
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Telephone | 419-435-3554
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Fax | 419-436-1994
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Provider Business Mailing Address
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Address Line | 614 W LYTLE ST
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City | FOSTORIA
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State | OH
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Zip | 44830-3422
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Country | US
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Telephone | 419-435-3554
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Fax | 419-436-1994
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 36-00-3099-K
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 36003099
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License Number State | OH
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