Healthcare Provider Details

I. General information

NPI: 1194042614
Provider Name (Legal Business Name): KNODEL ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 N CENTRAL AVE
CHICAGO IL
60634-2732
US

IV. Provider business mailing address

3936 N CENTRAL AVE
CHICAGO IL
60634-2732
US

V. Phone/Fax

Practice location:
  • Phone: 224-595-1096
  • Fax: 773-685-2416
Mailing address:
  • Phone: 224-595-1096
  • Fax: 773-685-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number347C00000X
License Number StateIL

VIII. Authorized Official

Name: ERICH H KNODEL
Title or Position: PRESIDENT
Credential:
Phone: 224-595-1096