=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649323809
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK A KIEFER PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 03/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 E NATIONAL AVE STE 100
-----------------------------------------------------
City | BRAZIL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47834-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-442-2820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10330 N MERIDIAN ST # 300
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46290-1024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 10000044A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------