# CHARLES G KISSEL DPM PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013001221
- **Authorized official:** CINDY SMITH (MANAGER)
- **Authorized official phone:** (586) 574-0500

## Contact information

- **Practice address:** 29433 RYAN RD, WARREN, MI 48092-2203
- **Practice address phone:** (586) 574-0500
- **Practice address fax:** (586) 574-2694
- **Mailing address:** 29433 RYAN RD, WARREN, MI 48092-2203
- **Mailing address phone:** (586) 574-0500
- **Mailing address fax:** (586) 574-2694

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | CK000960 | MI | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | MS00843 | MI | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | ZH002007 | MI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | CK000960 | MI | — |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/02/2012