MEDICARE: CARL J KISSLING MD

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
1	207P00000X	Emergency Medicine Physician	N4525	TX
2	207Q00000X	Family Medicine Physician	N4525	TX
3	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	N4525	TX

General Provider Information

NPI Number	:	1699754846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL J KISSLING MD

Provider Business Mailing Address
First Line	:	3818 ECHO BROOK LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-5221
Country	:	US
Telephone Number	:	214-484-8930
Fax Number	:

Provider Business Practice Location Address
First Line	:	3818 ECHO BROOK LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-5221
Country	:	US
Telephone Number	:	214-484-8930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2006
Last Update Date	:	07/17/2015

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