Individual
HASSAN KIESO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3800 W 203RD ST, SUITE 204, OLYMPIA FIELDS, IL 60461-1184
(708) 679-2670
(708) 503-3260
Mailing address
1040 SIERRA DRIVE, SUITE 400, GREENWOOD, IN 46143-7241
(317) 528-4253
(317) 865-8319
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036092223
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092223
—
IL
01
—
L95559
MEDICARE PTAN
IL
Enumeration date
04/24/2006
Last updated
01/10/2020
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