Provider Demographics
NPI:1093469348
Name:KIERAN SURGICAL, LLC
Entity Type:Organization
Organization Name:KIERAN SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KIERAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-717-0502
Mailing Address - Street 1:1058 BANKS ROSE ST
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4839
Mailing Address - Country:US
Mailing Address - Phone:646-717-0502
Mailing Address - Fax:
Practice Address - Street 1:1058 BANKS ROSE ST
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4839
Practice Address - Country:US
Practice Address - Phone:646-717-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty