Provider Demographics
NPI:1265454367
Name:KIEL, MARY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:KIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509TH MEDICAL GROUP
Mailing Address - Street 2:331 SIJAN AVENUE
Mailing Address - City:WHITEMAN AFB
Mailing Address - State:MO
Mailing Address - Zip Code:65305
Mailing Address - Country:US
Mailing Address - Phone:660-687-2188
Mailing Address - Fax:
Practice Address - Street 1:509TH MEDICAL GROUP
Practice Address - Street 2:331 SIJAN AVENUE
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305
Practice Address - Country:US
Practice Address - Phone:660-687-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060447A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics