Healthcare Provider Details

I. General information

NPI: 1700090602
Provider Name (Legal Business Name): ERIC DAVID KNAPP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD STE 207
MISHAWAKA IN
46545-1465
US

IV. Provider business mailing address

5215 HOLY CROSS PKWY PROVIDER SERVICES-ENROLLMENT
MISHAWAKA IN
46545-1469
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-6850
  • Fax: 574-335-0849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number02003840A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number02003840A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: