MEDICARE: KARYSSA SCHROUDER KNOPOFF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036158888	IL
2	208000000X	Pediatrics Physician	125.073838	IL
3	2080P0207X	Pediatric Hematology & Oncology Physician	036158888	IL
4	2080P0207X	Pediatric Hematology & Oncology Physician	01098699A	IN

General Provider Information

NPI Number	:	1376005298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARYSSA SCHROUDER KNOPOFF MD

Provider Business Mailing Address
First Line	:	180 HARVESTER DR STE 110
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6686
Country	:	US
Telephone Number	:	773-702-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # MC4060
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	773-702-6808
Fax Number	:	773-702-9881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	04/06/2026

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