Healthcare Provider Details

I. General information

NPI: 1619387099
Provider Name (Legal Business Name): JOHN MICHAEL KIEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF EMERGENCY MEDICINE, 125 FLOOR CLINICAL CE 655 WEST 8TH STREET, C506
JACKSONVILLE FL
32209-3220
US

IV. Provider business mailing address

DEPARTMENT OF EMERGENCY MEDICINE 655 WEST 8TH STREET, C506
JACKSONVILLE FL
32209-3504
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-6340
  • Fax:
Mailing address:
  • Phone: 904-244-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number04183
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberTP002
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberOS15506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: