Healthcare Provider Details

I. General information

NPI: 1023214335
Provider Name (Legal Business Name): JAMES MICHAEL KNAUF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 W MORELAND AVE
ADDISON IL
60101-3867
US

IV. Provider business mailing address

294 N HADDON PL
ADDISON IL
60101-2145
US

V. Phone/Fax

Practice location:
  • Phone: 630-543-0043
  • Fax:
Mailing address:
  • Phone: 630-628-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: