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General NPI Number Information
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NPI Number | 1396887717
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Entity Type | Individual
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Provider Name | JOHN LUCAS KIESEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10510 LAGRANGE RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-1277
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Country | US
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Telephone | 502-253-7317
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Fax | 502-253-7477
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Provider Business Mailing Address
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Address Line | 720 BLANKENBAKER LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-1040
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Country | US
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Telephone | 502-897-1639
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 14805
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License Number State | KY
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