Provider Demographics
NPI:1477500817
Name:HITEN KISNAD MD PA
Entity Type:Organization
Organization Name:HITEN KISNAD MD PA
Other - Org Name:BEACHES PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HITEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:KISNAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-270-2217
Mailing Address - Street 1:320 1ST ST N
Mailing Address - Street 2:SUITE 614
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6944
Mailing Address - Country:US
Mailing Address - Phone:904-270-2217
Mailing Address - Fax:904-270-2232
Practice Address - Street 1:320 1ST ST N
Practice Address - Street 2:STE 614
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6944
Practice Address - Country:US
Practice Address - Phone:904-270-2217
Practice Address - Fax:904-270-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00664822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3767Medicare ID - Type Unspecified