Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 12658 | NH |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1770 | ME |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 223633 | MA |
N | 207Q00000X | Family Doctor | 12658 | NH |
N | 207Q00000X | Family Doctor | 1770 | ME |
Y | 207Q00000X | Family Doctor | 223633 | MA |
NPI | 1043219470 |
---|---|
Provider Name | Dr. Stephen Lewis Kisiel |
First Address | Pittsfield, MA 01201-4624 |
Second Address | Pittsfield, MA 01201-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 15/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10100817 | CDPHP (01) | MA |
214532 | CIGNA (01) | MA |
233633 | CONNECTICARE (01) | MA |
31730 | BMC HEALTHNET PLAN (01) | MA |
37109 | HEALTH NEW ENGLAND (01) | MA |
3958618 | AETNA (01) | MA |
4146652 | MVP/GOLUB (01) | MA |
486859 | TUFTS (01) | MA |
9768190 | (05) | MA |
I42775 | (02) | MA |
J28997 | BCBS (01) | MA |