Provider Demographics
NPI:1740273325
Name:KINDERKNECHT, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KINDERKNECHT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 CREEKSIDE BLVD EAST
Mailing Address - Street 2:102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:239-624-1700
Mailing Address - Fax:239-624-0311
Practice Address - Street 1:1285 CREEKSIDE BLVD EAST
Practice Address - Street 2:102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109
Practice Address - Country:US
Practice Address - Phone:239-624-1700
Practice Address - Fax:239-624-0311
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME172804207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203746706Medicaid
MO203746714Medicaid
MO025011950Medicare PIN
MOE60044Medicare UPIN
MO200020361Medicare PIN
MO203746714Medicaid
MOP00415621Medicare PIN
MO966985236Medicare PIN