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Organization

CHARLES G KISSEL DPM PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES G KISSEL DPM (PARTNER)
(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
213E00000X
Podiatrist
Primary
CK000960
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12268
M-CARE
MI
05
1715614
MI
01
21171
OMNI
MI
01
2559787
CIGNA
MI
01
480017380
MCRR
MI
01
480017711
MCRR
MI
01
480E011810
BCBSM
MI
01
480F335300
BCBSM
MI
01
480Q245670
BCBSM
MI
05
4949617
MI
01
5137446
FIRST HEALTH
MI
01
5972192
AETNA
MI
01
5987390001
DME
MI
01
6087740001
DME
MI
01
P00422721
MCRR
MI
01
P44714
B PLUS
MI
Enumeration date
02/06/2008
Last updated
05/16/2008
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