Provider Demographics
NPI:1881791978
Name:ZIESER, KENT H (DO)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:H
Last Name:ZIESER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 MEDICAL CENTER DR STE 314
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-6851
Mailing Address - Country:US
Mailing Address - Phone:724-395-6399
Mailing Address - Fax:469-204-6976
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 314
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:972-439-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA138506207R00000X
TXL9973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169250103Medicaid
1881791978OtherNPI
NMP00406313OtherRAILROAD MEDICARE PIN
NM41572882Medicaid
TX169250102Medicaid
NM204669563OtherTIN
TX169250102Medicaid
NM41572882Medicaid
NMP00406313OtherRAILROAD MEDICARE PIN
TX351184YKQJMedicare PIN