Organization
CHARLES G KISSEL DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY SMITH (MANAGER)
(586) 574-0500
Entity
Organization
Contact information
Practice address
29433 RYAN RD, WARREN, MI 48092-2203
(586) 574-0500
(586) 574-2694
Mailing address
29433 RYAN RD, WARREN, MI 48092-2203
(586) 574-0500
(586) 574-2694
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
CK000960
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
MS00843
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
ZH002007
MI
332B00000X
Durable Medical Equipment & Medical Supplies
CK000960
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134865123
—
MI
01
—
480017711
MCRR
MI
01
—
480E011810
BCBS
MI
01
—
540E026180
BCDME
MI
01
—
5901002214
LICENSE
MI
01
—
CK000960
LICENSE
MI
01
—
MS000843
LICENSE
MI
01
—
ZH002007
LICENSE
MI
Enumeration date
10/03/2006
Last updated
08/02/2012
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