Provider Demographics
NPI:1942278916
Name:KIES, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:KIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:64 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-5265
Mailing Address - Fax:573-334-3648
Practice Address - Street 1:64 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-5265
Practice Address - Fax:573-334-3648
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR9461207W00000X
IL036092978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507464709Medicaid
IL10032015OtherBLUECROSS BLUESHIELD
MO133468OtherUNITED HEALTHCARE
115157OtherHEALTHLINK
MO145920OtherHEALTH ALLIANCE
MO863002OtherFIRST HEALTH
IL115157OtherHEALTHLINK
MO334132OtherGROUP HEALTH PLAN
MO9206OtherBLUE CROSS BLUE SHIELD
MO9206OtherBLUE CROSS BLUE SHIELD
MO133468OtherUNITED HEALTHCARE
MO334132OtherGROUP HEALTH PLAN