Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 34902 | KY |
N | 111NI0900X | Internist | 34902 | KY |
N | 207RC0200X | Critical Care Medicine | 34902 | KY |
N | 207RP1001X | Pulmonary Disease | 01064503A | IN |
Y | 207RP1001X | Pulmonary Disease | 34902 | KY |
N | 2080P0214X | Pediatric Pulmonologist | 34902 | KY |
NPI | 1588673370 |
---|---|
Provider Name | David Michael Hiestand |
First Address | Louisville, KY 40202-1332 |
Second Address | Louisville, KY 40202-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 18/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64079270 | (05) | KY |
I06330 | (02) |