Provider Demographics
NPI:1003189648
Name:HIESTER, KURT J (PA-C)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:J
Last Name:HIESTER
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5315 ELLIOTT DR
Mailing Address - Street 2:STE 102
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8634
Mailing Address - Country:US
Mailing Address - Phone:734-434-4110
Mailing Address - Fax:734-434-1966
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:STE 102
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-434-4110
Practice Address - Fax:734-434-1966
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2017-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant