Provider Demographics
NPI:1861455156
Name:KIELL, CHARLES STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEVEN
Last Name:KIELL
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:5255 E STOP 11 RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6341
Practice Address - Country:US
Practice Address - Phone:317-528-1212
Practice Address - Fax:317-528-1252
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072900A208600000X, 2086X0206X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9834OtherPARTNERS
NC8948921Medicaid
NC020032139OtherRAIL ROAD MEDICARE
NC280000OtherMAMSI
NC48921OtherBLUE CROSS BLUE SHIELD NC
NC657768OtherFIRST HEALTH
NCA8803OtherMEDCOST
NC657768OtherFIRST HEALTH
NC8948921Medicaid