MEDICARE: DR. KARL KISCH PA-C

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	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant	0110006213	VA
3	363AM0700X	Medical Physician Assistant	344	HI

General Provider Information

NPI Number	:	1811979669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL KISCH PA-C

Provider Business Mailing Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER, UNIT 33100
Second Line	:
City	:	APO
State	:	AE
Zip	:	09180
Country	:	US
Telephone Number	:	314-590-2240
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER, UNIT 33100
Second Line	:
City	:	APO
State	:	AE
Zip	:	09180
Country	:	US
Telephone Number	:	314-590-2240
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	12/22/2022

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