Provider Demographics
NPI:1043219470
Name:KISIEL, STEPHEN LEWIS (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:KISIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SUMMER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4624
Mailing Address - Country:US
Mailing Address - Phone:413-442-0085
Mailing Address - Fax:413-464-9143
Practice Address - Street 1:42 SUMMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4624
Practice Address - Country:US
Practice Address - Phone:413-442-0085
Practice Address - Fax:413-464-9143
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223633204D00000X, 207Q00000X
ME1770204D00000X, 207Q00000X
NH12658204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10100817OtherCDPHP
MA214532OtherCIGNA
MA31730OtherBMC HEALTHNET PLAN
MA4146652OtherMVP/GOLUB
MA37109OtherHEALTH NEW ENGLAND
MA3958618OtherAETNA
MA9768190Medicaid
MAJ28997OtherBCBS
MA233633OtherCONNECTICARE
MA486859OtherTUFTS
MA3958618OtherAETNA