MEDICARE: DR. CHARLES STEVEN KIELL M.D.

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	208600000X	Surgery Physician	01072900A	IN
2	2086X0206X	Surgical Oncology Physician	01072900A	IN
3	2086S0129X	Vascular Surgery Physician	01072900A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020032139	OTHER	NC	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	280000	OTHER	NC	MAMSI
3	48921	OTHER	NC	BLUE CROSS BLUE SHIELD NC
4	9834	OTHER	NC	PARTNERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	657768	OTHER	NC	FIRST HEALTH
7	A8803	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1861455156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES STEVEN KIELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	5255 E STOP 11 RD STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-6341
Country	:	US
Telephone Number	:	317-528-1212
Fax Number	:	317-528-1252

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

Provider Enumeration Date	:	04/09/2006
Last Update Date	:	04/15/2025

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Directions to “ DR. CHARLES STEVEN KIELL M.D.” Practice Location

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