Healthcare Provider Details

I. General information

NPI: 1659075943
Provider Name (Legal Business Name): FELTON KNIGHTON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FELTON EDWARD KNIGHTON JR. PA-C

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 HIGHLAND AVE STE 200A
DOWNERS GROVE IL
60515-2100
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 844-376-3876
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085009858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: