Provider Demographics
NPI:1720798663
Name:KIEFER, KIM (BHS)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:BHS
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 611693
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-1693
Mailing Address - Country:US
Mailing Address - Phone:989-371-8277
Mailing Address - Fax:989-283-7588
Practice Address - Street 1:28823 ROCKWOOD ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3251
Practice Address - Country:US
Practice Address - Phone:989-371-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI92-0835427OtherAUTO INSURANCE