Healthcare Provider Details

I. General information

NPI: 1225064702
Provider Name (Legal Business Name): WILLIAM E. C. KNOBELOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIAM EDWIN CULLEN KNOBELOCH MD

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N CLEVELAND AVE STE 200
WESTERVILLE OH
43082-9845
US

IV. Provider business mailing address

540 N CLEVELAND AVE STE 200
WESTERVILLE OH
43082-9845
US

V. Phone/Fax

Practice location:
  • Phone: 614-891-9505
  • Fax: 614-891-6416
Mailing address:
  • Phone: 614-891-9505
  • Fax: 614-891-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.077057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: