Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 98 | CT |
Y | 222Z00000X | Podiatrist | 98 | CT |
N | 213ES0103X | Foot & Ankle Surgery | 98 | CT |
NPI | 1093140162 |
---|---|
Provider Name | Dr. Kenneth R Kierstein |
First Address | Waterford, CT 06385-1234 |
Second Address | Waterford, CT 06385-1234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 09/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U | (02) | CT |