Provider Demographics
NPI:1083860563
Name:KNIESER, MARTIAL RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIAL
Middle Name:RAYMOND
Last Name:KNIESER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 178
Mailing Address - Street 2:7399 N SHADELAND AVE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2052
Mailing Address - Country:US
Mailing Address - Phone:317-288-0370
Mailing Address - Fax:
Practice Address - Street 1:16267 OAKFORD TRL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7391
Practice Address - Country:US
Practice Address - Phone:317-288-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0102828A2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine