MEDICARE: MR. TODD P. KIELMAN PA-C, MPAS

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	363A00000X	Physician Assistant

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922102250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD P. KIELMAN PA-C, MPAS

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-0813

Provider Business Practice Location Address
First Line	:	506 GRAHAM DR STE 150
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-3346
Country	:	US
Telephone Number	:	281-351-5174
Fax Number	:	281-351-5172

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	12/17/2019

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Directions to “ MR. TODD P. KIELMAN PA-C, MPAS” Practice Location

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