Provider Demographics
NPI:1457328528
Name:KIESSLING, LOU ANN (MD)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:ANN
Last Name:KIESSLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOU ANN
Other - Middle Name:KIESSLING
Other - Last Name:LEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:405 S CLARK ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3065
Mailing Address - Country:US
Mailing Address - Phone:712-792-8255
Mailing Address - Fax:712-792-8256
Practice Address - Street 1:405 S CLARK ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3065
Practice Address - Country:US
Practice Address - Phone:712-792-8255
Practice Address - Fax:712-792-8256
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31091207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1139030Medicaid
IA1139030Medicaid
IAE49891Medicare UPIN