Provider Demographics
NPI:1326595935
Name:CAROLA KIEVE, MD
Entity Type:Organization
Organization Name:CAROLA KIEVE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-344-1479
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-9901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 LENA ST
Practice Address - Street 2:C1
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4339
Practice Address - Country:US
Practice Address - Phone:505-660-4093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-05982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM309942Medicare UPIN