Basic Information
| Provider Information | |||||||||
| NPI: | 1770726556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIEFER | ||||||||
| FirstName: | ED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 W SAINT CLAIR ST | ||||||||
| Address2: | |||||||||
| City: | ROMEO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480654656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867529296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1270 DORIS RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483262617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482768000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2009 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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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 | 104100000X | 6802085280 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.