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General NPI Number Information
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NPI Number | 1992975817
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Entity Type | Individual
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Provider Name | URSULA KISIEL M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 3560 A1A S
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-9731
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Country | US
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Telephone | 904-584-2273
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Fax | 904-429-9783
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Provider Business Mailing Address
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Address Line | 129 PALM TRL
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City | EAST PALATKA
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State | FL
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Zip | 32131-4186
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Country | US
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Telephone | 248-312-8085
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 117483
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License Number State | FL
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