Provider Demographics
NPI:1194386078
Name:KISER, KELLY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:KISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1104 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3094
Mailing Address - Country:US
Mailing Address - Phone:217-442-2631
Mailing Address - Fax:217-442-0119
Practice Address - Street 1:1104 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3094
Practice Address - Country:US
Practice Address - Phone:217-442-2631
Practice Address - Fax:217-442-0119
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019018427207W00000X, 207R00000X
IL036.171912207W00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery