Healthcare Provider Details

I. General information

NPI: 1760483788
Provider Name (Legal Business Name): RALF K KIEHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW
SIDNEY MT
59270
US

IV. Provider business mailing address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2504
  • Fax: 406-488-2553
Mailing address:
  • Phone: 406-488-2504
  • Fax: 406-488-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number200385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: