MEDICARE: HERMAN JOSEPH KIESLER JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-069304	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134196355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMAN JOSEPH KIESLER JR. M.D.

Provider Business Mailing Address
First Line	:	2830 VICTORY PKWY STE 120
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1786
Country	:	US
Telephone Number	:	513-245-3052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 KEMPER MEADOW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1633
Country	:	US
Telephone Number	:	513-648-9077
Fax Number	:	513-648-9554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	05/21/2013

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