Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2301007338 | MI |
NPI | 1972565059 |
---|---|
Provider Name | Dr. Robert Jefferson Kisling |
First Address | Traverse City, MI 49696-6711 |
Second Address | Traverse City, MI 49684-4146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 03/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C 65633 | (02) |