1821144916 NPI number — MR. WILLIAM JOHN KIEFIUK OD

Table of content: MR. WILLIAM JOHN KIEFIUK OD (NPI 1821144916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821144916 NPI number — MR. WILLIAM JOHN KIEFIUK OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIEFIUK
Provider First Name:
WILLIAM
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821144916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5016 WAVEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-1362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-249-4793
Provider Business Mailing Address Fax Number:
734-853-3798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22320 GODDARD RD
Provider Second Line Business Practice Location Address:
SVS
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-287-3311
Provider Business Practice Location Address Fax Number:
734-759-3092
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003019 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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