Provider Demographics
NPI:1336241892
Name:KISS, ALEXANDER (MD PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KISS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2522
Mailing Address - Country:US
Mailing Address - Phone:813-782-2946
Mailing Address - Fax:813-782-4027
Practice Address - Street 1:6751 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2522
Practice Address - Country:US
Practice Address - Phone:813-602-8805
Practice Address - Fax:813-602-8533
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME000561042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061272300Medicaid
08470Medicare PIN
08470XMedicare PIN