Healthcare Provider Details

I. General information

NPI: 1548588239
Provider Name (Legal Business Name): MATTHEW KNEDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 W HERNDON AVE STE 105
FRESNO CA
93722-8401
US

IV. Provider business mailing address

1303 E HERNDON AVE STE 850
FRESNO CA
93720-3309
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-2663
  • Fax: 559-450-2723
Mailing address:
  • Phone: 559-450-2663
  • Fax: 559-450-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA120052
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036.140314
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: