Provider Demographics
NPI:1679557581
Name:KNEDLER, LINDA KAY (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:KNEDLER
Suffix:
Gender:F
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:PO BOX160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420
Mailing Address - Country:US
Mailing Address - Phone:505-368-7010
Mailing Address - Fax:505-368-7011
Practice Address - Street 1:US HWY 491 N
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-7010
Practice Address - Fax:505-358-7011
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053932K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ852683Medicaid
CO16889274Medicaid
NM81001231Medicaid
CO16889274Medicaid
E89097Medicare UPIN
AZ852683Medicaid