| Organization Name: | CHARLES G KISSEL DPM PC |
| NPI Number: | 1013001221 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CINDY SMITH (MANAGER) |
| Mailing Address: | 29433 Ryan Rd Warren |
| State: | MI US |
| Postal Code: | 480922203 |
| Phone Number: | 5865740500 |
| Fax Number: | 5865742694 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 08/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | CK000960 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |