Healthcare Provider Details

I. General information

NPI: 1982623666
Provider Name (Legal Business Name): KEITH E. KNEPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S MAJOR ST
EUREKA IL
61530-1246
US

IV. Provider business mailing address

PO BOX 2451
BLOOMINGTON IL
61702-2451
US

V. Phone/Fax

Practice location:
  • Phone: 309-467-4691
  • Fax: 309-467-6229
Mailing address:
  • Phone: 309-268-2172
  • Fax: 309-268-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: