MEDICARE: RONALD L KISSEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	4301101860	MI

General Provider Information

NPI Number	:	1851484356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD L KISSEL M.D.

Provider Business Mailing Address
First Line	:	423 SYCAMORE ST STE 103
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-2374
Country	:	US
Telephone Number	:	269-479-3030
Fax Number	:	269-479-3032

Provider Business Practice Location Address
First Line	:	423 SYCAMORE ST STE 103
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-2374
Country	:	US
Telephone Number	:	269-479-3030
Fax Number	:	269-479-3032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/12/2019

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