MEDICARE: KENDAL CHARLES KNAUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	18175	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295731842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDAL CHARLES KNAUS MD

Provider Business Mailing Address
First Line	:	PO BOX 1064
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-1064
Country	:	US
Telephone Number	:	719-587-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 BLANCA AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2340
Country	:	US
Telephone Number	:	719-587-1223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	04/03/2012

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