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NPI Code Detail

MEDICARE: DR HENRY KISER LLC

MEDICARE: DR HENRY KISER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician22656LA

General Provider Information

NPI Number : 1396138756
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR HENRY KISER LLC
Provider Business Mailing Address
First Line : PO BOX 1684
Second Line :
City : SHREVEPORT
State : LA
Zip : 71165-1684
Country : US
Telephone Number : 318-424-4008
Fax Number : 318-424-6606
Provider Business Practice Location Address
First Line : 2525 VIKING DR
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2103
Country : US
Telephone Number : 318-841-2525
Fax Number : 318-425-8438
Authorized Official
Title or Position : OWNER
Name : HENRY J KISER
Credential : MD
Telephone Number : 318-426-1094
Provider Enumeration Date : 03/10/2015
Last Update Date : 03/12/2015

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