=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265426381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH MARIE KNIPPLE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2005
-----------------------------------------------------
Last Update Date | 05/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5999 NEW WILKE RD BLDG 2
-----------------------------------------------------
City | ROLLING MEADOWS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60008-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-618-0800
-----------------------------------------------------
Fax | 847-228-1062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5999 NEW WILKE RD BLDG 2
-----------------------------------------------------
City | ROLLING MEADOWS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60008-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-618-0800
-----------------------------------------------------
Fax | 847-228-1062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036-086821
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------