MEDICARE: STEFAN GUENTER KIESSLING 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	2080P0210X	Pediatric Nephrology Physician	38641	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699791038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN GUENTER KIESSLING MD

Provider Business Mailing Address
First Line	:	2333 ALUMNI PARK PLZ
Second Line	:	SUITE 200
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4012
Country	:	US
Telephone Number	:	859-257-7910
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-323-5481
Fax Number	:

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/14/2008

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