Healthcare Provider Details

I. General information

NPI: 1598969644
Provider Name (Legal Business Name): DAVID A. KNIGHT MD, PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 76TH ST STE 1200
PLEASANT PRAIRIE WI
53158-1984
US

IV. Provider business mailing address

6308 8TH AVENUE ATTN: MEDICAL STAFF
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-671-7300
  • Fax: 262-671-7315
Mailing address:
  • Phone: 262-656-3313
  • Fax: 262-653-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036113675
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01064963A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number55540
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: