1811232150 NPI number — DAVID JAMES KNOCKE RPH MS

Table of content: MS. JANNELL TAYLOR LPC (NPI 1285968685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811232150 NPI number — DAVID JAMES KNOCKE RPH MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOCKE
Provider First Name:
DAVID
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH MS
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:
1811232150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 PERTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60013-2648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-462-0611
Provider Business Mailing Address Fax Number:
847-462-0611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 PERTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60013-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-462-0611
Provider Business Practice Location Address Fax Number:
847-462-0611
Provider Enumeration Date:
11/27/2012

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: 183500000X , with the licence number:  10359-40 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 051.292548 , 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)