Provider Demographics
NPI:1649595836
Name:KISCHNICK, DANIEL BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRUCE
Last Name:KISCHNICK
Suffix:
Gender:M
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:PO BOX 950293
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0293
Mailing Address - Country:US
Mailing Address - Phone:888-987-1875
Mailing Address - Fax:405-609-1491
Practice Address - Street 1:327 EASTBROOKE POINTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-5561
Practice Address - Country:US
Practice Address - Phone:502-538-5090
Practice Address - Fax:502-538-4089
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201176530Medicaid
KY7100166220Medicaid
IN201176530Medicaid