Provider Demographics
NPI:1508181066
Name:KISSEL, ABIGAIL MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:MARION
Last Name:KISSEL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6300
Mailing Address - Fax:833-969-0138
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED ACADEMICS, STE 2C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6300
Practice Address - Fax:833-969-0138
Is Sole Proprietor?:No
Enumeration Date:2010-03-28
Last Update Date:2024-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2022017930208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200110878Medicaid