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NPI Code Detail

MEDICARE: DR. MICHAEL CHARLES KIELY DPM

MEDICARE: DR. MICHAEL CHARLES KIELY DPM
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
1213E00000XPodiatrist016005794IL
2213ES0131XFoot Surgery Podiatrist016005794IL

General Provider Information

NPI Number : 1295106805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL CHARLES KIELY DPM
Provider Business Mailing Address
First Line : 1005 BROADWAY ST
Second Line :
City : QUINCY
State : IL
Zip : 62301-2834
Country : US
Telephone Number : 217-223-1200
Fax Number :
Provider Business Practice Location Address
First Line : 4800 MAINE ST
Second Line :
City : QUINCY
State : IL
Zip : 62305-5875
Country : US
Telephone Number : 217-214-3823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2015
Last Update Date : 12/31/2025

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