Provider Demographics
NPI:1295731727
Name:KISHIUE, RICHARD M (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:KISHIUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:865 LINCOLN RD
Practice Address - Street 2:STE 100
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4159
Practice Address - Country:US
Practice Address - Phone:563-355-1000
Practice Address - Fax:563-344-2975
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA23445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
035512OtherHEALTH ALLIANCE
IA0141OtherJOHN DEERE HEALTH PLAN
IA4212043Medicaid
29599OtherWELLMARK BC/BS
019811OtherIOWA HEALTH SOLUTIONS
4796890005OtherDMERC
IA4212043Medicaid
29599OtherWELLMARK BC/BS