Provider Demographics
NPI:1215098587
Name:KIERSTEIN, ROBERT B (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:KIERSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 N.E. 128TH ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-5331
Mailing Address - Fax:425-899-5333
Practice Address - Street 1:11903 NE 128TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7209
Practice Address - Country:US
Practice Address - Phone:425-899-5331
Practice Address - Fax:425-899-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000268213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1522101Medicaid
WAAK8796926OtherDEA
WA1522101Medicaid
WA102726Medicare PIN
WAT60948Medicare UPIN