Provider Demographics
NPI:1700692159
Name:KNEUSS, FREDERICK CHARLES III
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:CHARLES
Last Name:KNEUSS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7073 LAKESIDE FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-4063
Mailing Address - Country:US
Mailing Address - Phone:810-210-6858
Mailing Address - Fax:
Practice Address - Street 1:7073 LAKESIDE FARMS CIR
Practice Address - Street 2:
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-4063
Practice Address - Country:US
Practice Address - Phone:810-210-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-192671163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine