Healthcare Provider Details

I. General information

NPI: 1598286940
Provider Name (Legal Business Name): DIANE MARIE KUEHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLD WATERBURY RD
SOUTHBURY CT
06488-3848
US

IV. Provider business mailing address

5008 N MARY MARTIN DR
APPLETON WI
54913-8061
US

V. Phone/Fax

Practice location:
  • Phone: 203-262-4200
  • Fax:
Mailing address:
  • Phone: 616-227-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73822
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301113414
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number73822
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78134
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: