Provider Demographics
NPI:1396801973
Name:KIESERMAN, MICHEAL ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:ALLAN
Last Name:KIESERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 NEW SALEM RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-4833
Mailing Address - Country:US
Mailing Address - Phone:518-765-2151
Mailing Address - Fax:518-765-3375
Practice Address - Street 1:680 NEW SALEM RD
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186-4833
Practice Address - Country:US
Practice Address - Phone:518-765-2151
Practice Address - Fax:518-765-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00582389Medicaid