Provider Demographics
NPI:1427119155
Name:KIELE, JAN ERIC (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:ERIC
Last Name:KIELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 DEBARR RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3104
Mailing Address - Country:US
Mailing Address - Phone:907-406-3620
Mailing Address - Fax:907-885-1059
Practice Address - Street 1:4600 DEBARR RD STE 150
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3104
Practice Address - Country:US
Practice Address - Phone:907-885-1089
Practice Address - Fax:907-885-1059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS49652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD92172Medicaid
A99795Medicare UPIN