MEDICARE: DR. ROBERT EDWARD KNEISLEY M.D.

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	207Q00000X	Family Medicine Physician	35042766	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35-042766	OTHER	OH	OHIO LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1679598163	OTHER	OH	NPI

General Provider Information

NPI Number	:	1679598163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD KNEISLEY M.D.

Provider Business Mailing Address
First Line	:	247 S BURNETT RD
Second Line	:	SUITE 210
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2639
Country	:	US
Telephone Number	:	937-328-8850
Fax Number	:	937-328-8860

Provider Business Practice Location Address
First Line	:	247 S BURNETT RD
Second Line	:	SUITE 210
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2639
Country	:	US
Telephone Number	:	937-328-8850
Fax Number	:	937-328-8860

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/07/2023

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