Healthcare Provider Details

I. General information

NPI: 1811979669
Provider Name (Legal Business Name): KARL KISCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 12/22/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER, UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER, UNIT 33100
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2240
  • Fax:
Mailing address:
  • Phone: 314-590-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110006213
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number344
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: