Provider Demographics
NPI:1710994686
Name:KILSTEIN, BRUCE I (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:I
Last Name:KILSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:207 QUAKER LANE
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893
Practice Address - Country:US
Practice Address - Phone:401-828-7110
Practice Address - Fax:401-827-6364
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00640208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5079481OtherAETNA
RIAA336911OtherHARVARD PILGRIM
RIP01281046OtherRAILROAD MCR
FL6562991OtherCIGNA
RIBK95604Medicaid
RIP01277535OtherRAILROAD MCR
RIU400114436Medicare PIN
RIP01277535OtherRAILROAD MCR
RIAA336911OtherHARVARD PILGRIM