Provider Demographics
NPI:1609883354
Name:KISSEL, DAVID ERIC (MD PH D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:KISSEL
Suffix:
Gender:M
Credentials:MD PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-479-4433
Mailing Address - Fax:502-451-5949
Practice Address - Street 1:2020 NEWBURG RD
Practice Address - Street 2:PSYCHIATRY DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1803
Practice Address - Country:US
Practice Address - Phone:502-451-3330
Practice Address - Fax:502-451-5949
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY258942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64258940Medicaid
IN201062670AMedicaid
KY1525401Medicare ID - Type Unspecified
KYP01040373 RRMedicare PIN
IN201062670AMedicaid
KY64258940Medicaid