MEDICARE: DR. KENNETH RICHARD KNECHT 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	2080P0202X	Pediatric Cardiology Physician	16151	MS
2	2080P0202X	Pediatric Cardiology Physician	E6105	AR

General Provider Information

NPI Number	:	1790769586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RICHARD KNECHT MD

Provider Business Mailing Address
First Line	:	1 CHILDRENS WAY # 653
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3500
Country	:	US
Telephone Number	:	501-364-1100
Fax Number	:	501-364-4082

Provider Business Practice Location Address
First Line	:	1 CHILDRENS WAY # 512-3
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3500
Country	:	US
Telephone Number	:	501-364-1479
Fax Number	:	501-364-3667

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	11/13/2024

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