MEDICARE: CSABA KISS 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	207R00000X	Internal Medicine Physician	E1737	AR

General Provider Information

NPI Number	:	1811985187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CSABA KISS MD

Provider Business Mailing Address
First Line	:	PO BOX 2420
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-2420
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	1501 S WALDRON RD
Second Line	:	STE 100
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2574
Country	:	US
Telephone Number	:	479-709-7310
Fax Number	:	479-709-7315

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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