Provider Demographics
NPI:1003131616
Name:KIEVLAN, DANIEL RHODES (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RHODES
Last Name:KIEVLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL PLAZA DR STE 250
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3477
Mailing Address - Country:US
Mailing Address - Phone:281-296-8788
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL PLAZA DR STE 250
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3477
Practice Address - Country:US
Practice Address - Phone:281-296-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454066207RC0200X, 207P00000X
CAA118857207P00000X
TXR3889207P00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377732801Medicaid