Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 5101009105 | MI |
NPI | 1013925080 |
---|---|
Provider Name | Dr. Craig Thomas Kuesel |
First Address | Traverse City, MI 49684-8102 |
Second Address | Traverse City, MI 49684-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114231632 | (05) | MI |
F03758 | (02) |