Provider Demographics
NPI:1063482834
Name:KIEL, RAPHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:JOSEPH
Last Name:KIEL
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 1:22301 FOSTER WINTER DRIVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-557-3506
Practice Address - Street 1:22301 FOSTER WINTER DRIVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:248-557-3506
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301062244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B45417Medicare UPIN