1598732489 NPI number — DR. MARK RAYMOND KNABEL M.D.

Table of content: CINDY DUCKLOW (NPI 1417183500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598732489 NPI number — DR. MARK RAYMOND KNABEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNABEL
Provider First Name:
MARK
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1598732489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 DELHI ST STE 4100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-6362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-557-5900
Provider Business Mailing Address Fax Number:
563-557-5905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 DELHI ST
Provider Second Line Business Practice Location Address:
STE 4100
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001-6358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-557-5900
Provider Business Practice Location Address Fax Number:
563-557-5905
Provider Enumeration Date:
03/01/2006

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: 174400000X , with the licence number:  22086 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: 24706-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0263558 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1598732489 . This is a "NPI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 386682104 . This is a "ILLINOIS PUBLIC AID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 421462387 . This is a "MISCELLANEOUS INSURANCE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 13070 . This is a "DEAN HEALTHCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0107 . This is a "JOHN DEERE HEALTHCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 55736 . This is a "WELLMARK BCBS NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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