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Individual

DR. HEATHER KISTKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
500 ARCADE AVE STE 200, ELKHART, IN 46514-2485
(574) 294-8404
(574) 523-1642
Mailing address
50615 FOX TRL, GRANGER, IN 46530-9040
(615) 400-8549

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
01076916A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201365900
IN
Enumeration date
04/24/2009
Last updated
11/07/2024
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