Healthcare Provider Details

I. General information

NPI: 1134324056
Provider Name (Legal Business Name): BRIAN KIEKOVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

6515 NW 27TH TER
GAINESVILLE FL
32653-1518
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5911
  • Fax:
Mailing address:
  • Phone: 616-560-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: