Provider Demographics
NPI:1790013100
Name:JULIA KISSEL MD INC.
Entity Type:Organization
Organization Name:JULIA KISSEL MD INC.
Other - Org Name:BODYLOGICMD OF CINCINNATI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-246-5131
Mailing Address - Street 1:4555 LAKE FOREST DR
Mailing Address - Street 2:STE 580
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3785
Mailing Address - Country:US
Mailing Address - Phone:877-246-5131
Mailing Address - Fax:877-246-5132
Practice Address - Street 1:4555 LAKE FOREST DR
Practice Address - Street 2:STE 580
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3785
Practice Address - Country:US
Practice Address - Phone:877-246-5131
Practice Address - Fax:877-246-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty