Basic Information
| Provider Information | |||||||||
| NPI: | 1619387099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIEL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF EMERGENCY MEDICINE | ||||||||
| Address2: | 655 WEST 8TH STREET, C506 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322093504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042446340 | ||||||||
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| Practice Location | |||||||||
| Address1: | DEPARTMENT OF EMERGENCY MEDICINE, 125 FLOOR CLINICAL CE | ||||||||
| Address2: | 655 WEST 8TH STREET, C506 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322093220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042446340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 04183 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207QS0010X | TP002 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207PS0010X | OS15506 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
No ID Information.