Individual
DR. MICHAEL W KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 WASHINGTON ST, STE 510, SAN DIEGO, CA 92103-2231
(619) 819-6501
Mailing address
PO BOX 910514, SAN DIEGO, CA 92191-0514
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G17434
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G174340
—
CA
Enumeration date
05/23/2006
Last updated
05/07/2008
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