Provider Demographics
NPI:1265536692
Name:CIRESI, KEVIN FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
Last Name:CIRESI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5201 NORRIS CANYON RD
Mailing Address - Street 2:#110
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-275-1685
Mailing Address - Fax:925-275-0625
Practice Address - Street 1:5201 NORRIS CANYON RD
Practice Address - Street 2:#110
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-275-1685
Practice Address - Fax:925-275-0625
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60858208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G608581Medicare ID - Type Unspecified
S17991Medicare UPIN