Provider Demographics
NPI:1467773002
Name:KIEL, MARK JULIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JULIN
Last Name:KIEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CATHERINE ST
Mailing Address - Street 2:4211 MED SCI I
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2026
Mailing Address - Country:US
Mailing Address - Phone:734-764-3270
Mailing Address - Fax:734-936-7361
Practice Address - Street 1:1301 CATHERINE ST
Practice Address - Street 2:4211 MED SCI I
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2026
Practice Address - Country:US
Practice Address - Phone:734-764-3270
Practice Address - Fax:734-936-7361
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096757390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program