=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427093087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LES T. SANDKNOP, D.O. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6785 HORIZON RD #100
-----------------------------------------------------
City | HEATH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-7711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-771-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1029
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75087-1029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-771-9081
-----------------------------------------------------
Fax | 972-772-7102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LES T. SANDKNOP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-771-9081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | F5359
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------