Provider Demographics
NPI:1699873729
Name:KNOEDLER, WILLIAM HENRY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:KNOEDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3813 S MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2357
Mailing Address - Country:US
Mailing Address - Phone:608-266-0721
Mailing Address - Fax:608-266-3638
Practice Address - Street 1:108 S WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3494
Practice Address - Country:US
Practice Address - Phone:608-266-0721
Practice Address - Fax:608-266-3638
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI180502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF18061Medicare UPIN