Provider Demographics
NPI:1710571039
Name:M. KISH MCLEOD, DO
Entity type:Organization
Organization Name:M. KISH MCLEOD, DO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:KISH
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:251-943-1584
Mailing Address - Street 1:1511 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2297
Mailing Address - Country:US
Mailing Address - Phone:251-943-1584
Mailing Address - Fax:
Practice Address - Street 1:1511 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2297
Practice Address - Country:US
Practice Address - Phone:251-943-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty