Provider Demographics
NPI:1457399305
Name:KISH, LOUIS STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:STEPHEN
Last Name:KISH
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:PO BOX 40450
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0450
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:26410 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4067
Practice Address - Country:US
Practice Address - Phone:440-835-6194
Practice Address - Fax:440-892-9160
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-4799207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH070000891OtherMEDICARE RAILROAD PIN
OH0525560Medicaid
OHC46420Medicare UPIN
OH0533151Medicare PIN