Provider Demographics
NPI:1164700159
Name:KIEFFER, THEODORE WILLIAM (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:WILLIAM
Last Name:KIEFFER
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:
Other - Last Name:KIEFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:350 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4108
Mailing Address - Country:US
Mailing Address - Phone:317-833-4172
Mailing Address - Fax:
Practice Address - Street 1:350 W 11TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4108
Practice Address - Country:US
Practice Address - Phone:317-833-4172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11016195A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology