Individual
KENNETH W DISTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2130 MARSHALL CT, SAGINAW, MI 48602-3351
(989) 799-0600
(989) 799-6080
Mailing address
2130 MARSHALL CT, SAGINAW, MI 48602-3351
(989) 799-0600
(989) 799-6080
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
KD046952
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1681561
—
MI
01
—
KD046952
LICENSE
MI
Enumeration date
10/24/2006
Last updated
07/09/2007
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