Individual
KEVIN LOUIS CISCHKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
6145 HIDDENBROOK DR, TOLEDO, OH 43613-1522
(734) 755-2728
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
RN.416348
OH
363LF0000X
Family Nurse Practitioner
Primary
4704341344
MI
363LF0000X
Family Nurse Practitioner
APRN.CNP.023948
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704341344
STATE OF MICHIGAN LICENSE
MI
Enumeration date
11/01/2018
Last updated
10/11/2022
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