Provider Demographics
NPI:1679521900
Name:KISS, KAROLY O (MD)
Entity Type:Individual
Prefix:
First Name:KAROLY
Middle Name:O
Last Name:KISS
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 1:2261 PADDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2428
Mailing Address - Country:US
Mailing Address - Phone:727-784-3230
Mailing Address - Fax:
Practice Address - Street 1:26812 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3405
Practice Address - Country:US
Practice Address - Phone:727-799-2727
Practice Address - Fax:727-210-0810
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71546ZMedicare ID - Type Unspecified
FLD58108Medicare UPIN