Provider Demographics
NPI:1386608156
Name:KIESSLING, BRUCE J (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:KIESSLING
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2440 E TUDOR RD
Mailing Address - Street 2:PMB 1168
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1185
Mailing Address - Country:US
Mailing Address - Phone:907-646-2559
Mailing Address - Fax:907-562-1319
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:STE. 322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-562-1234
Practice Address - Fax:907-561-8550
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
AK1224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1224OtherLICENSE
AKMD1224Medicaid
AKMD1224Medicaid
E51234Medicare UPIN
AKMD1224Medicaid