Individual
BRETT M KISSELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 PIEDMONT AVE, SUITE 3200, CINCINNATI, OH 45219
(513) 475-8730
(513) 475-8033
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-0001
(513) 585-5504
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
35076768
OH
2084N0400X
Neurology Physician
36148
KY
2084V0102X
Vascular Neurology Physician
35.076768
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0894696
MEDICARE PTAN
OH
05
—
2180232
—
OH
Enumeration date
06/23/2006
Last updated
11/13/2017
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