Provider Demographics
NPI:1861966202
Name:KNEEWELL LLC
Entity type:Organization
Organization Name:KNEEWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-213-2879
Mailing Address - Street 1:4175 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2869
Mailing Address - Country:US
Mailing Address - Phone:612-213-2879
Mailing Address - Fax:612-254-8245
Practice Address - Street 1:4175 ARBOR LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2869
Practice Address - Country:US
Practice Address - Phone:612-213-2879
Practice Address - Fax:612-254-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4786380OtherDEPARTMENT OF REVENUE