Provider Demographics
NPI:1679549349
Name:KIEL, KRYSTYNA D (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTYNA
Middle Name:D
Last Name:KIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3804
Mailing Address - Country:US
Mailing Address - Phone:312-942-5751
Mailing Address - Fax:312-942-2339
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8490
Practice Address - Fax:912-350-8819
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0611072085R0001X
IL0360656962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065696Medicaid
C39351Medicare UPIN