MEDICARE: KELLY J KIEHM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	35080525	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000483231	OTHER	OH	ANTHEM PIN
3	4982480003	OTHER	OH	DMEPOS

General Provider Information

NPI Number	:	1588654370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J KIEHM MD

Provider Business Mailing Address
First Line	:	3600 OLENTANGY RIVER RD
Second Line	:	STE 480
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3485
Country	:	US
Telephone Number	:	614-442-0700
Fax Number	:	614-678-8851

Provider Business Practice Location Address
First Line	:	3600 OLENTANGY RIVER RD
Second Line	:	BLDG 480
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3437
Country	:	US
Telephone Number	:	614-300-1105
Fax Number	:	614-678-8851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/19/2020

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Directions to “ KELLY J KIEHM MD” Practice Location

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