Healthcare Provider Details

I. General information

NPI: 1699896027
Provider Name (Legal Business Name): TRACEY LYNN KNOTT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY LIAKOS D.O.

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 S ARIZONA MILLS CIR
TEMPE AZ
85282-6401
US

IV. Provider business mailing address

4530 E SHEA BLVD STE 180
PHOENIX AZ
85028-6042
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-4000
  • Fax: 480-539-7033
Mailing address:
  • Phone: 602-264-4834
  • Fax: 602-254-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number036.124716
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number006517
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: