Emily Marie Kisor, MD | |
1627 E Bristol St, Elkhart, IN 46514-3817 | |
(574) 262-0313 | |
Not Available |
Full Name | Emily Marie Kisor |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 1627 E Bristol St, Elkhart, Indiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659614964 | NPI | - | NPPES |
201354790 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 01076081 (Indiana) | Primary |
Entity Name | Beacon Medical Group Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1033161617 PECOS PAC ID: 1254243306 Enrollment ID: O20031105000657 |
Mailing Address | Practice Location Address |
---|---|
Emily Marie Kisor, MD 710 N Niles Ave, South Bend, IN 46617-1924 Ph: (574) 647-1610 | Emily Marie Kisor, MD 1627 E Bristol St, Elkhart, IN 46514-3817 Ph: (574) 262-0313 |
Dr. Shahir Okhovat-ghahfarokhi, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1627 E Bristol St, Elkhart, IN 46514 Phone: 574-262-0313 Fax: 574-389-4879 | |
Dr. Su Choo Chang, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1627 E Bristol St, Elkhart, IN 46514 Phone: 574-262-0313 Fax: 574-389-4879 | |
Christine Mamphey Dankwa, M.D., M.P.H Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 236 Simpson Ave, Elkhart, IN 46516 Phone: 574-293-0052 Fax: 514-970-3256 | |
Sandra H. Morgan, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1627 E Bristol St, Elkhart, IN 46514 Phone: 574-262-0313 Fax: 574-262-8163 | |
Jody L Srof, FNP Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1627 E Bristol St, Elkhart, IN 46514 Phone: 574-262-0313 Fax: 574-262-8163 | |
Jared Ray Dhaemers, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1627 E Bristol St, Elkhart, IN 46514 Phone: 574-262-0313 Fax: 574-262-8163 |