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General NPI Number Information
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NPI Number | 1740271964
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Entity Type | Organization
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Legal Business Name | KNAPP MEDICAL CENTER, LTD.
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 3303 S HALSTED ST SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60608-6705
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Country | US
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Telephone | 773-890-0800
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Fax | 773-890-5430
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Provider Business Mailing Address
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Address Line | 3303 S HALSTED ST SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60608-6705
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Country | US
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Telephone | 773-890-0800
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Fax | 773-890-5430
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Authorized Official
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Title or Position | CORP. PRESIDENT
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Name | KEITH CHARLES KNAPP JR.
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Credential | M.D.
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Telephone | 773-890-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-62820
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License Number State | IL
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