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General NPI Number Information
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NPI Number | 1851565998
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Entity Type | Organization
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Legal Business Name | NORTHERN INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 04/19/2008
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 1920 S STRAITS HWY
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City | INDIAN RIVER
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State | MI
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Zip | 49749-9792
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Country | US
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Telephone | 231-238-0160
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Fax | 231-238-0153
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Provider Business Mailing Address
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Address Line | PO BOX 927
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City | INDIAN RIVER
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State | MI
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Zip | 49749-0927
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Country | US
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Telephone | 231-238-0160
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Fax | 231-238-0153
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY J KIEL
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Credential | DO
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Telephone | 231-238-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | JK010369
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License Number State | MI
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