1043498652 NPI number — CHARLES G KISSEL DPM PC

Table of content: (NPI 1043498652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043498652 NPI number — CHARLES G KISSEL DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES G KISSEL DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043498652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29433 RYAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48092-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-574-0500
Provider Business Mailing Address Fax Number:
586-574-2694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29433 RYAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48092-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-574-0500
Provider Business Practice Location Address Fax Number:
586-574-2694
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KISSEL
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
586-574-0500

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  CK000960 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5137446 . This is a "FIRST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480F335300 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4949617 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5987390001 . This is a "DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12268 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 21171 . This is a "OMNI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2559787 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480Q245670 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1715614 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480017711 . This is a "MCRR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5972192 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6087740001 . This is a "DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P44714 . This is a "B PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480017380 . This is a "MCRR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00422721 . This is a "MCRR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480E011810 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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