Healthcare Provider Details

I. General information

NPI: 1205435237
Provider Name (Legal Business Name): ALBERT J KISER AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 01/25/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N GRAND AVE STE 101
FORT THOMAS KY
41075-1765
US

IV. Provider business mailing address

40 N GRAND AVE STE 103
FORT THOMAS KY
41075-1765
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-4900
  • Fax: 859-572-3039
Mailing address:
  • Phone: 859-781-4900
  • Fax: 859-572-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA.02272
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number282796
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: