Individual
DR. KENNETH VICTOR MISELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
445 W POPLAR ST, STOCKTON, CA 95203-2426
(209) 465-5933
(209) 465-2562
Mailing address
445 W POPLAR ST, STOCKTON, CA 95203-2426
(209) 465-5933
(209) 465-2562
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00G502810
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0761830001
MEDICARE DMERC
CA
01
—
180033368
RAILROAD MEDICARE
CA
05
—
GR0050600
—
CA
Enumeration date
02/22/2006
Last updated
03/23/2009
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