MEDICARE: JOHN D KEHL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601001735	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	371573958	OTHER	MI	TAX ID

General Provider Information

NPI Number	:	1013023621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D KEHL PA

Provider Business Mailing Address
First Line	:	11275 SPRAGUE RD
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-8493
Country	:	US
Telephone Number	:	269-623-7121
Fax Number	:	269-623-5527

Provider Business Practice Location Address
First Line	:	11275 SPRAGUE RD
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-8493
Country	:	US
Telephone Number	:	269-623-7121
Fax Number	:	269-623-5527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	06/25/2010

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Directions to “ JOHN D KEHL PA” Practice Location

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