Provider Demographics
NPI:1790774701
Name:KISH, JULIE A (M D, FACP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:KISH
Suffix:
Gender:F
Credentials:M D, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 MAGNOLIA DRIVE MCC-SA
Mailing Address - Street 2:H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-3822
Mailing Address - Fax:813-745-1908
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067902207RX0202X
TXG6191207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258818800Medicaid
FLAM086ZMedicare PIN
TX177708801Medicaid