Provider Demographics
NPI:1770659872
Name:KISLOV, DANIEL E (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:KISLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1675 LEAHY STREET
Mailing Address - Street 2:SUITE 328
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5543
Mailing Address - Country:US
Mailing Address - Phone:231-727-5565
Mailing Address - Fax:231-727-5568
Practice Address - Street 1:1675 LEAHY STREET
Practice Address - Street 2:SUITE 328
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5543
Practice Address - Country:US
Practice Address - Phone:231-727-5565
Practice Address - Fax:231-727-5568
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010429852086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery