Provider Demographics
NPI:1639104367
Name:KISSEL, JULIA M (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:KISSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10276 ALLIANCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4710
Mailing Address - Country:US
Mailing Address - Phone:513-206-9705
Mailing Address - Fax:513-342-6045
Practice Address - Street 1:10276 ALLIANCE RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4710
Practice Address - Country:US
Practice Address - Phone:513-206-9705
Practice Address - Fax:513-342-6045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3507379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149197Medicaid
OHKI7299671Medicare ID - Type Unspecified
OH2149197Medicaid