Individual
TRAVIS D KIECKBUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9480 DOUBLE DIAMOND PKWY, SUITE 100, RENO, NV 89521-5845
(775) 786-1600
(775) 786-7706
Mailing address
9480 DOUBLE DIAMOND PKWY, SUITE 100, RENO, NV 89521-5845
(775) 786-1600
(775) 786-7706
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
10356
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002016986
—
NV
01
—
11464586
CAQH
—
01
—
P01420439
RR MEDICARE
NV
Enumeration date
12/28/2006
Last updated
03/13/2018
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