Healthcare Provider Details

I. General information

NPI: 1508851460
Provider Name (Legal Business Name): JOSEPH FRANK KNEDGEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 S MCCARRAN BLVD SUITE D 1
RENO NV
89509-6140
US

IV. Provider business mailing address

6580 S MCCARRAN BLVD SUITE D 1
RENO NV
89509-6140
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-9559
  • Fax: 775-826-9546
Mailing address:
  • Phone: 775-826-9559
  • Fax: 775-826-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9707
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: