Provider Demographics
NPI:1306832407
Name:KISCH, AGNES I (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:I
Last Name:KISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20903 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5548
Mailing Address - Country:US
Mailing Address - Phone:281-578-5788
Mailing Address - Fax:281-578-8008
Practice Address - Street 1:20903 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:281-578-5788
Practice Address - Fax:281-578-8008
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F94252Medicare UPIN