Provider Demographics
NPI:1689646358
Name:KIEHL, FREDERICK D
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:KIEHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:D
Other - Last Name:KIEHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1007 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64469-4030
Mailing Address - Country:US
Mailing Address - Phone:816-449-2123
Mailing Address - Fax:816-449-2125
Practice Address - Street 1:1007 S POLK ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64469-4030
Practice Address - Country:US
Practice Address - Phone:816-449-2123
Practice Address - Fax:816-449-2125
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00088776OtherRAILROAD
MOP903985Medicare ID - Type Unspecified
MOC50353Medicare UPIN