Provider Demographics
NPI:1760483788
Name:KIEHL, RALF K (MD)
Entity Type:Individual
Prefix:DR
First Name:RALF
Middle Name:K
Last Name:KIEHL
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 1:214 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2504
Mailing Address - Fax:406-488-2553
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270
Practice Address - Country:US
Practice Address - Phone:406-488-2504
Practice Address - Fax:406-488-2553
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2003852085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592676Medicaid
G16716Medicare UPIN
NY56447CMedicare PIN