MEDICARE: NICHOLAI IAN KIEHL MD

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	208800000X	Urology Physician	35125593	OH
2	208800000X	Urology Physician	01073785A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	H411160	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124269055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAI IAN KIEHL MD

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11141 PARKVIEW PLAZA DR
Second Line	:	SUITE 320
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1713
Country	:	US
Telephone Number	:	260-482-8681
Fax Number	:	260-266-9240

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	10/02/2024

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Directions to “ NICHOLAI IAN KIEHL MD” Practice Location

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