MEDICARE: RENATA G KIEFER M.D.

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	208000000X	Pediatrics Physician	53596	MA

General Provider Information

NPI Number	:	1720222169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATA G KIEFER M.D.

Provider Business Mailing Address
First Line	:	6 LOCKSLEY AVE
Second Line	:	#10A
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-3854
Country	:	US
Telephone Number	:	415-731-3672
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 LOCKSLEY AVE APT 10A
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-3878
Country	:	US
Telephone Number	:	415-731-3672
Fax Number	:

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

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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