Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 2013009354 | MO |
NPI | 1043416985 |
---|---|
Provider Name | Dr. Nathan John Kiewiet |
First Address | Independence, MO 64057 |
Second Address | Kansas City, MO 64116-3274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2013009354 | MISSOURI LICENSE (01) | MO |