Healthcare Provider Details

I. General information

NPI: 1811988678
Provider Name (Legal Business Name): MICHAEL A KIGER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

IV. Provider business mailing address

647 ARMSTRONG RD
WEST WINFIELD NY
13491-3319
US

V. Phone/Fax

Practice location:
  • Phone: 315-287-1000
  • Fax:
Mailing address:
  • Phone: 315-624-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: