Basic Information
| Provider Information | |||||||||
| NPI: | 1689646358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIEHL | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KIEHL | ||||||||
| OtherFirstName: | FREDERICK | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1007 S POLK ST | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644694030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164492123 | ||||||||
| FaxNumber: | 8164492125 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 S POLK ST | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644694030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164492123 | ||||||||
| FaxNumber: | 8164492125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R8713 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00088776 | 01 | RAILROAD | OTHER |