Healthcare Provider Details

I. General information

NPI: 1174629091
Provider Name (Legal Business Name): GENE E KIELHORN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MAIN ST
BROOKLYN MI
49230-9114
US

IV. Provider business mailing address

244 RIVIERA DR
BROOKLYN MI
49230-9777
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-8033
  • Fax:
Mailing address:
  • Phone: 517-592-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007892
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: