Provider Demographics
NPI:1336337880
Name:R. STEFAN KIESZ M.D. P.A.
Entity Type:Organization
Organization Name:R. STEFAN KIESZ M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADOSLAW
Authorized Official - Middle Name:STEFAN
Authorized Official - Last Name:KIESZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-272-0098
Mailing Address - Street 1:18615 TUSCANY STONE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3498
Mailing Address - Country:US
Mailing Address - Phone:210-272-0098
Mailing Address - Fax:210-592-1462
Practice Address - Street 1:18615 TUSCAN STONE
Practice Address - Street 2:SUITE 170
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3498
Practice Address - Country:US
Practice Address - Phone:210-272-0098
Practice Address - Fax:210-592-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7769207RC0000X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161214501Medicaid
TX161214501Medicaid
TX00758VMedicare Oscar/Certification
TX1710924675Medicare PIN