Healthcare Provider Details

I. General information

NPI: 1851343602
Provider Name (Legal Business Name): CHRISTOPHER GLENN MCKNIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

IV. Provider business mailing address

3200 BURNET AVE 3 SOUTH
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8524
  • Fax: 513-475-8492
Mailing address:
  • Phone: 513-475-8524
  • Fax: 513-475-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0429390
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0429390
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35-095757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: