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General NPI Number Information
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NPI Number | 1194996603
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Entity Type | Organization
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Legal Business Name | VINCENT E C KIESEL MD PA
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 1200 S PINELLAS AVE SUITE 1
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-3728
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Country | US
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Telephone | 727-938-1581
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Fax | 727-938-1583
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Provider Business Mailing Address
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Address Line | 1200 S PINELLAS AVE SUITE 1
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-3728
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Country | US
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Telephone | 727-938-1581
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Fax | 727-938-1583
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Authorized Official
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Title or Position | OWNER
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Name | VINCENT E C KIESEL
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Credential | MD
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Telephone | 727-938-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME36082
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License Number State | FL
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