Individual
DR. CHARLES GREGORY KISSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
29433 RYAN RD, WARREN, MI 48092-2203
(586) 574-0500
(586) 574-2694
Mailing address
29433 RYAN RD, WARREN, MI 48092-2203
(586) 574-0500
(586) 574-2694
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901000960
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1715614
—
MI
05
—
2932693
—
MI
05
—
4585272
—
MI
01
—
480E011810
BCBSM
MI
01
—
480F330020
BCBSM
MI
01
—
480F335300
BCBSM
MI
01
—
480Q24567
BCBSM
MI
05
—
4949617
—
MI
01
—
T34053
UPIN
MI
Enumeration date
08/15/2005
Last updated
10/24/2014
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