Provider Demographics
NPI:1487076725
Name:KISH, SPENCER
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:
Last Name:KISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 US ONE N
Mailing Address - Street 2:#271
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2746
Mailing Address - Country:US
Mailing Address - Phone:561-401-6717
Mailing Address - Fax:561-833-6418
Practice Address - Street 1:177 US ONE N
Practice Address - Street 2:#271
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2746
Practice Address - Country:US
Practice Address - Phone:561-401-6717
Practice Address - Fax:561-833-6418
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies