Individual
DR. TIM C KISABETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
270 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052
(618) 498-4166
(618) 639-7997
Mailing address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-7518
(618) 498-3052
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-073254
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073254
—
IL
Enumeration date
08/25/2005
Last updated
11/13/2024
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