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NPI Code Detail

MEDICARE: DR. PHILLIP LEE KISER M.D.

MEDICARE: DR. PHILLIP LEE KISER 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
1207Q00000XFamily Medicine Physician00046836WA
2207Q00000XFamily Medicine Physician40616KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
140616OTHERKYMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000511094OTHERKYANTHEM

General Provider Information

NPI Number : 1356446447
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILLIP LEE KISER M.D.
Provider Business Mailing Address
First Line : PO BOX 635283
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-5283
Country : US
Telephone Number : 859-905-3070
Fax Number : 859-441-1348
Provider Business Practice Location Address
First Line : 1400 GRAND AVE
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2570
Country : US
Telephone Number : 859-905-3070
Fax Number : 859-441-1348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 03/27/2024

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