Provider Demographics
NPI:1699103697
Name:KIESEL, TONU (MD)
Entity type:Individual
Prefix:
First Name:TONU
Middle Name:
Last Name:KIESEL
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 1:258 ELK GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-9794
Mailing Address - Country:US
Mailing Address - Phone:307-746-2035
Mailing Address - Fax:
Practice Address - Street 1:258 ELK GROVE TRL
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-9794
Practice Address - Country:US
Practice Address - Phone:307-746-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2270A208600000X
MN17348208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND80165Medicare UPIN