Individual
DANIEL RYAN KISICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4017 RAWLINS ST, CHEYENNE, WY 82001-1800
(307) 635-2562
(307) 638-2074
Mailing address
1950 BLUEGRASS CIR, SUITE 200, CHEYENNE, WY 82009-7323
(307) 778-2577
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301092823
MI
207Q00000X
Family Medicine Physician
Primary
9010A
WY
207QS0010X
Sports Medicine (Family Medicine) Physician
9010A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902060833
—
WY
Enumeration date
07/10/2008
Last updated
10/28/2022
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