Active NPI
Kenneth W Distler, MD
- Specialist
- Saginaw, MI
National Provider Identifier
1598849903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- KD046952
- Practice address
- 2130 Marshall CT
Saginaw, MI 48602-3351 - Phone
- (989) 799-0600
- Fax
- (989) 799-6080
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | KD046952 | MI | Primary |
Addresses
Primary practice location
2130 Marshall CT
Saginaw, MI 48602-3351
Mailing address
2130 Marshall CT
Saginaw, MI 48602-3351
Phone (989) 799-0600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1681561 | Medicaid | MI | |
| KD046952 | Other | MI | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KD046952 | MI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1598849903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2130 MARSHALL CT",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486023351",
"telephone_number": "989-799-0600",
"fax_number": "989-799-6080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 MARSHALL CT",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486023351",
"telephone_number": "989-799-0600",
"fax_number": "989-799-6080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTLER",
"first_name": "KENNETH",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MI",
"license": "KD046952",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1681561",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "KD046952",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.