Healthcare Provider Details

I. General information

NPI: 1134196355
Provider Name (Legal Business Name): HERMAN JOSEPH KIESLER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HERMAN JOSEPH KIESLER, JR. M.D.

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 KEMPER MEADOW DR
CINCINNATI OH
45240-1633
US

IV. Provider business mailing address

2830 VICTORY PKWY STE 120
CINCINNATI OH
45206-1786
US

V. Phone/Fax

Practice location:
  • Phone: 513-648-9077
  • Fax: 513-648-9554
Mailing address:
  • Phone: 513-245-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-069304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: