Provider Demographics
NPI:1801969076
Name:GOETA KREISLER, KEVIN S (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:S
Last Name:GOETA KREISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6408 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-885-5558
Mailing Address - Fax:520-885-5559
Practice Address - Street 1:6408 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-885-5558
Practice Address - Fax:520-885-5559
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG1691872084P0800X
AZ22102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ16381602Medicaid
AZ27190Medicare PIN
AZ16381602Medicaid