Organization
PHILLIP KISSEL MD, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP KISSEL M.D (OWNER)
(805) 544-4455
Entity
Organization
Contact information
Practice address
699 CALIFORNIA BLVD STE A, SAN LUIS OBISPO, CA 93401-2507
(805) 544-4455
Mailing address
699 CALIFORNIA BLVD STE A, SAN LUIS OBISPO, CA 93401-2507
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
G53048
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G530480
—
CA
01
—
G53048
STATE LISCENSE
CA
Enumeration date
08/31/2006
Last updated
07/09/2008
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