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NPI Code Detail

MEDICARE: MR. KAHLE T RIEDEL

MEDICARE:  MR. KAHLE T RIEDEL
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1295235349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KAHLE T RIEDEL
Provider Business Mailing Address
First Line : 1615 FOLSOM DOWNS CIR
Second Line :
City : DIXON
State : CA
Zip : 95620-4829
Country : US
Telephone Number : 707-386-6073
Fax Number :
Provider Business Practice Location Address
First Line : 3780 ROSIN CT STE 130
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1644
Country : US
Telephone Number : 916-363-1553
Fax Number : 916-363-1638
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2018
Last Update Date : 03/17/2018

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