Provider Demographics
NPI:1770589988
Name:KISS, STEPHEN C (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:KISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1865
Mailing Address - Country:US
Mailing Address - Phone:865-524-3131
Mailing Address - Fax:865-212-6323
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:STE 206
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1865
Practice Address - Country:US
Practice Address - Phone:865-524-3131
Practice Address - Fax:865-212-6323
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD021237207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN390007329OtherRAILROAD MEDICARE
TN3158710OtherBCBS
TN4404715OtherAETNA US HEALTHCARE
TN3057744Medicaid
TN602003832OtherCARITEN HEALTHCARE
TN602003832OtherCARITEN HEALTHCARE
TN3158710OtherBCBS