Provider Demographics
NPI:1548277411
Name:KILSTEIN, SEYMOUR S (DO)
Entity type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:S
Last Name:KILSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E PAR ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4003
Mailing Address - Country:US
Mailing Address - Phone:877-876-3627
Mailing Address - Fax:321-841-4101
Practice Address - Street 1:303 E PAR ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4003
Practice Address - Country:US
Practice Address - Phone:877-876-3627
Practice Address - Fax:321-841-4101
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009206208800000X
KY03532208800000X
FLOS19677208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117381400Medicaid
KYP01523367OtherRAILROAD MEDICARE
VA1548277411Medicaid
KY7100227000Medicaid
OH310917085204OtherOHIO MEDICAID CARESOURCE
OH2804095OtherOHIO MEDICAID MOLINA
WV3810014454Medicaid