Healthcare Provider Details

I. General information

NPI: 1699059295
Provider Name (Legal Business Name): MICHAEL JOSEPH KIES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2011
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N HICKS RD
PALATINE IL
60067-3608
US

IV. Provider business mailing address

545 N HICKS RD
PALATINE IL
60067-3608
US

V. Phone/Fax

Practice location:
  • Phone: 847-963-4175
  • Fax:
Mailing address:
  • Phone: 847-963-4175
  • Fax: 847-963-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.295270
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: