| Doctor Name: | PHILLIP A KISSACK |
| NPI Number: | 1376530030 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RD LD |
| License Number: | 01464 |
| Business Practice Address: | 200 Hawkins Dr Iowa City, IA - 522421009 |
| Business Phone Number: | 3193846204 |
| Business Fax Number: | 3193568674 |
| Mailing Address: | 200 Hawkins Dr, IOWA CITY |
| State: | IA |
| Postal Code: | 522421009 |
| Phone Number: | 3193846204 |
| Fax Number: | 3193568674 |
| NPI Enumeration Date: | 09/28/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 01464 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |