Provider Demographics
NPI:1164408209
Name:JOEL KNEITZ MD PA
Entity Type:Organization
Organization Name:JOEL KNEITZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:KNEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-997-6000
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4479
Mailing Address - Country:US
Mailing Address - Phone:830-997-6000
Mailing Address - Fax:830-997-6040
Practice Address - Street 1:205 W WINDCREST ST
Practice Address - Street 2:SUITE 250
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4479
Practice Address - Country:US
Practice Address - Phone:830-997-6000
Practice Address - Fax:830-997-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1227207R00000X, 207RE0101X, 207RG0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00844HMedicaid
TXG89671Medicare UPIN