Provider Demographics
NPI:1821407644
Name:KINDERKNECHT, WILLIAM JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:KINDERKNECHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:806 HIGHWAY 2 N
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3625
Mailing Address - Country:US
Mailing Address - Phone:918-421-6795
Mailing Address - Fax:918-421-6791
Practice Address - Street 1:4 E. CLARK BASS BLVD.
Practice Address - Street 2:SUITE 301A
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-421-6795
Practice Address - Fax:918-421-6791
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK390200000X
OK5862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program