Provider Demographics
NPI:1669631230
Name:KIELHORN, ERIC PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:KIELHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1992
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:5300 HARROUN RD STE 10
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2182
Practice Address - Country:US
Practice Address - Phone:419-824-1952
Practice Address - Fax:419-824-0344
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250512832085R0001X
MI53150524632085R0001X
OH350970342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669631230Medicaid
OHP00987219OtherRR MEDICARE
OH3150772Medicaid
OH3150772Medicaid
OHP00987219OtherRR MEDICARE