Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO00000268 | WA |
NPI | 1215098587 |
---|---|
Provider Name | Dr. Robert B. Kierstein |
First Address | Kirkland, WA 98034 |
Second Address | Kirkland, WA 98034-7209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1522101 | (05) | WA |
AK8796926 | DEA (01) | WA |
T60948 | (02) | WA |