Provider Demographics
NPI:1992975817
Name:KISIEL, URSULA (MD)
Entity type:Individual
Prefix:DR
First Name:URSULA
Middle Name:
Last Name:KISIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PALM TRL
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-4186
Mailing Address - Country:US
Mailing Address - Phone:248-312-8085
Mailing Address - Fax:
Practice Address - Street 1:3560 A1A S
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-9731
Practice Address - Country:US
Practice Address - Phone:904-584-2273
Practice Address - Fax:904-429-9783
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine