Provider Demographics
NPI:1467600775
Name:KNOX, KEVIN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:KNOX
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 1:535 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4224
Mailing Address - Country:US
Mailing Address - Phone:732-333-8720
Mailing Address - Fax:
Practice Address - Street 1:113 W ESSEX ST STE 204
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1023
Practice Address - Country:US
Practice Address - Phone:201-289-5551
Practice Address - Fax:201-843-2390
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA117892002082S0105X
IN01068570A208200000X
WI72528207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001048836OtherANTHEM PROVIDER PIN UNDER TIN 35-2030653
IN000000671549OtherANTHEM PROVIDER NUMBER
WI100097468Medicaid
IN200997200Medicaid
INM400051928Medicare UPIN
IN000000671549OtherANTHEM PROVIDER NUMBER
IN815500178Medicare PIN