Provider Demographics
NPI:1629330535
Name:SISK, KEVIN C (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:SISK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1128
Mailing Address - Country:US
Mailing Address - Phone:402-426-2182
Mailing Address - Fax:
Practice Address - Street 1:812 N 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1128
Practice Address - Country:US
Practice Address - Phone:402-426-4611
Practice Address - Fax:402-426-4642
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015015493207Q00000X
NE1178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine