Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 56349 | MN |
NPI | 1003058546 |
---|---|
Provider Name | Dr. Samuel Branch Kieley |
First Address | Woodbury, MN 55125-1712 |
Second Address | Woodbury, MN 55125-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 12/09/2013 |