Miselis, Kenneth Victor

Miselis, Kenneth Victor is an sole proprietor health care provider with primary practice located at 445 W Poplar St , Stockton CA 95203-2426. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Miselis, Kenneth Victor can be contacted via phone (209) 465-5933.

Contact Information

Primary practice address
445 W Poplar St Stockton CA 95203-2426
Phone: (209) 465-5933
Fax: (209) 465-2562
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 00G502810 California

Profile Details

NPI number 1730154592
LBN Legal business name Miselis, Kenneth Victor
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 22nd, 2006
Last updated Mar 23rd, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730154592 NPPES
California Other 180033368 RAILROAD MEDICARE
California Other 0761830001 RAILROAD MEDICARE
California MEDICAID GR0050600 RAILROAD MEDICARE

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