Keith William Miessau, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL 1930 Issued in FL

Practice address

655 Longwood Lake Mary Rd
Lake Mary, FL 32746-3701

Phone

(407) 320-9753

NPI assigned

Feb 28, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1750357869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 HUNTERS STAND RUN",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327655100",
            "telephone_number": "407-619-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 LONGWOOD LAKE MARY RD",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463701",
            "telephone_number": "407-320-9753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIESSAU",
        "first_name": "KEITH",
        "middle_name": "WILLIAM",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL 1930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adam Miller, DMD

• All providers in Lake Mary, FL
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.