Provider Demographics
NPI:1528041589
Name:KLEINSTEUBER, WALTER KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:KENNETH
Last Name:KLEINSTEUBER
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 1:159 RARELY RIDDEN LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-9575
Mailing Address - Country:US
Mailing Address - Phone:270-692-0592
Mailing Address - Fax:
Practice Address - Street 1:159 RARELY RIDDEN LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-9575
Practice Address - Country:US
Practice Address - Phone:270-692-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64255664Medicaid
KYD32238Medicare UPIN
KY0661609Medicare ID - Type Unspecified