Provider Demographics
NPI:1588654370
Name:KIEHM, KELLY J (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:KIEHM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 480
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3485
Mailing Address - Country:US
Mailing Address - Phone:614-442-0700
Mailing Address - Fax:614-678-8851
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:BLDG 480
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-300-1105
Practice Address - Fax:614-678-8851
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-02-19
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Provider Licenses
StateLicense IDTaxonomies
OH35080525207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2647112Medicaid
OH000000483231OtherANTHEM PIN
OH4982480003OtherDMEPOS
OHKI4183142Medicare PIN
OH000000483231OtherANTHEM PIN
OH2647112Medicaid