Provider Demographics
NPI:1356446447
Name:KISER, PHILLIP LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LEE
Last Name:KISER
Suffix:
Gender:M
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-905-3070
Mailing Address - Fax:859-441-1348
Practice Address - Street 1:1400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2570
Practice Address - Country:US
Practice Address - Phone:859-905-3070
Practice Address - Fax:859-441-1348
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00046836207Q00000X
KY40616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40616OtherMEDICAL LICENSE
KY7100015240Medicaid
KY000000511094OtherANTHEM
KY7100015240Medicaid
KY00338001Medicare PIN