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General NPI Number Information
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NPI Number | 1184878340
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Entity Type | Organization
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Legal Business Name | KEITH O KIELMEYER MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 5536 E LANE AVE
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City | FRESNO
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State | CA
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Zip | 93727-5336
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Country | US
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Telephone | 559-970-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 5536 E LANE AVE
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City | FRESNO
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State | CA
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Zip | 93727-5336
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Country | US
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Telephone | 559-970-3411
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH O KIELMEYER
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Credential | M.D.
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Telephone | 559-970-3411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C35402
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License Number State | CA
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