Healthcare Provider Details

I. General information

NPI: 1902034374
Provider Name (Legal Business Name): INNOVATIVE DOCTOR GROUP LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W 35TH STREET 11TH FLOOR
CHICAGO IL
60616
US

IV. Provider business mailing address

2025 S ARLINGTON HEIGHTS ROAD SUITE #105
ARLINGTON HEIGHTS IL
60005-4152
US

V. Phone/Fax

Practice location:
  • Phone: 847-532-3580
  • Fax: 773-238-9782
Mailing address:
  • Phone: 847-437-2300
  • Fax: 847-437-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT P KNOTT
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 847-437-2300