Provider Demographics
NPI:1366076515
Name:KIELLE MEDICAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:KIELLE MEDICAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:KITONGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMINYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-767-0903
Mailing Address - Street 1:5988 DUCKWEED RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-5810
Mailing Address - Country:US
Mailing Address - Phone:561-767-0903
Mailing Address - Fax:
Practice Address - Street 1:5988 DUCKWEED RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-5810
Practice Address - Country:US
Practice Address - Phone:561-767-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty