Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2601001896 | MI |
Y | 213ES0000X | Sports Medicine | 2601001896 | MI |
NPI | 1164072732 |
---|---|
Provider Name | Travis Kiser |
First Address | Lansing, MI 48911-6520 |
Second Address | East Lansing, MI 48823-6363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2019 |
Last Update Date | 16/09/2019 |