Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 38641 | KY |
NPI | 1699791038 |
---|---|
Provider Name | Stefan Guenter Kiessling |
First Address | Lexington, KY 40517-4012 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64084551 | (05) | KY |
I10360 | (02) |