Healthcare Provider Details

I. General information

NPI: 1063768877
Provider Name (Legal Business Name): JOHN DAVID KNOCHEL D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16841 N 31ST AVE STE 134
PHOENIX AZ
85053-3057
US

IV. Provider business mailing address

16841 N 31ST AVE STE 134
PHOENIX AZ
85053-3057
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5501
  • Fax: 623-322-8996
Mailing address:
  • Phone: 623-322-5501
  • Fax: 623-322-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0758
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: