Provider Demographics
NPI:1013023621
Name:KEHL, JOHN D (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:KEHL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11275 SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-8493
Mailing Address - Country:US
Mailing Address - Phone:269-623-7121
Mailing Address - Fax:269-623-5527
Practice Address - Street 1:11275 SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:DELTON
Practice Address - State:MI
Practice Address - Zip Code:49046-8493
Practice Address - Country:US
Practice Address - Phone:269-623-7121
Practice Address - Fax:269-623-5527
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001735363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI371573958OtherTAX ID
MIR67132Medicare UPIN