Provider Demographics
NPI:1639280357
Name:KIEHL, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:KIEHL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:STE 5G
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-747-1970
Mailing Address - Fax:314-747-1972
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 5G
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-1970
Practice Address - Fax:314-747-1972
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-06-13
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Provider Licenses
StateLicense IDTaxonomies
MO107025207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO006010421Medicare PIN
MO006010421Medicaid