Provider Demographics
NPI:1619387099
Name:KIEL, JOHN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:KIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - Street 2:655 WEST 8TH STREET, C506
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-3504
Mailing Address - Country:US
Mailing Address - Phone:904-244-6340
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF EMERGENCY MEDICINE, 125 FLOOR CLINICAL CE
Practice Address - Street 2:655 WEST 8TH STREET, C506
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-3220
Practice Address - Country:US
Practice Address - Phone:904-244-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04183207P00000X
KYTP002207QS0010X
FLOS15506207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT3Q4WOtherBCBS
FL100401000Medicaid