MEDICARE: JEFFREY JAY KIEL DO

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	207R00000X	Internal Medicine Physician	JK010369	MI

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

General Provider Information

NPI Number	:	1720071657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY JAY KIEL DO

Provider Business Mailing Address
First Line	:	2030 S STRAITS HWY
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-9792
Country	:	US
Telephone Number	:	231-649-0935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 S STRAITS HWY
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-9792
Country	:	US
Telephone Number	:	231-649-0935
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	03/01/2023

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