Provider Demographics
NPI:1508851460
Name:KNEDGEN, JOSEPH FRANK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANK
Last Name:KNEDGEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE D 1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6140
Mailing Address - Country:US
Mailing Address - Phone:775-826-9559
Mailing Address - Fax:775-826-9546
Practice Address - Street 1:6580 S MCCARRAN BLVD
Practice Address - Street 2:SUITE D 1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6140
Practice Address - Country:US
Practice Address - Phone:775-826-9559
Practice Address - Fax:775-826-9546
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9707213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV30199Medicare PIN
NVU42875Medicare UPIN
NV1122640002Medicare NSC