Individual
KIET MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
204 W 26TH ST, ERIE, PA 16508-1806
(814) 864-4755
(814) 864-5430
Mailing address
204 W 26TH ST, ERIE, PA 16508-1806
(814) 864-4755
(814) 864-5430
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
OS019644
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2013
Last updated
10/02/2020
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