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Individual

JACKLYN D KIEFER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
533 E COUNTY LINE RD STE 101, GREENWOOD, IN 46143
(317) 957-9050
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02003257A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02003257A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2957966
OH
01
P00885864
RR MEDICARE
OH
Enumeration date
04/10/2007
Last updated
11/27/2023
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