Individual
DR. TIMOTHY DEAN KISTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
614 W LYTLE ST, FOSTORIA, OH 44830-3422
(419) 435-3554
(419) 436-1994
Mailing address
614 W LYTLE ST, FOSTORIA, OH 44830-3422
(419) 435-3554
(419) 436-1994
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
36-00-3099-K
OH
332B00000X
Durable Medical Equipment & Medical Supplies
36003099
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2092239
—
OH
01
—
480026415
MEDICARE RR
OH
Enumeration date
12/23/2005
Last updated
07/03/2008
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