1518901032 NPI number — MR. SANFORD I KNIGHT D.P.M.

Table of content: MR. SANFORD I KNIGHT D.P.M. (NPI 1518901032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518901032 NPI number — MR. SANFORD I KNIGHT D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT
Provider First Name:
SANFORD
Provider Middle Name:
I
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518901032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
434 WOODLAWN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENCOE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60022-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-612-4729
Provider Business Mailing Address Fax Number:
847-835-8003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 WOODLAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENCOE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60022-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-612-4729
Provider Business Practice Location Address Fax Number:
847-835-8003
Provider Enumeration Date:
06/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  07000826A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 016-004716 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200160970A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000224020 . This is a "ANTHEM BCBS INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4840180001 . This is a "DMERC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01628296 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 134297859 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000224021 . This is a "ANTHEM BCBS INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 016004716 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480025164 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4856050000 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".