Provider Demographics
NPI:1972502516
Name:KICHLER, JOEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:KICHLER
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 1:985 PENN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1160
Mailing Address - Country:US
Mailing Address - Phone:724-671-7909
Mailing Address - Fax:724-904-7953
Practice Address - Street 1:985 PENN ST STE A
Practice Address - Street 2:
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014-1160
Practice Address - Country:US
Practice Address - Phone:724-671-7909
Practice Address - Fax:724-904-7953
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-16
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019480E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA89587Medicare ID - Type Unspecified
PAB30579Medicare UPIN