Healthcare Provider Details

I. General information

NPI: 1699424705
Provider Name (Legal Business Name): SEAN KNIGHT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 LINCOLN ST NE
LE MARS IA
51031-3311
US

IV. Provider business mailing address

714 LINCOLN ST NE
LE MARS IA
51031-3311
US

V. Phone/Fax

Practice location:
  • Phone: 712-546-3398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO-55655
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: