Individual
JOHN M KISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
147 AMBER LN, WILKES BARRE, PA 18702-6545
(570) 824-1122
(570) 824-8012
Mailing address
610 WYOMING AVE, KINGSTON, PA 18704-3702
(570) 288-5441
(570) 288-5842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS004620L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001128093
—
PA
Enumeration date
06/23/2006
Last updated
09/13/2012
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