Provider Demographics
NPI:1891805982
Name:KNETSCHE, ROBERT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:KNETSCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1876
Mailing Address - Country:US
Mailing Address - Phone:859-238-7746
Mailing Address - Fax:859-236-0261
Practice Address - Street 1:236 W MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1876
Practice Address - Country:US
Practice Address - Phone:859-238-7746
Practice Address - Fax:859-236-0261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY42368207XS0117X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100090390Medicaid