MEDICARE: LACY A KNIGHT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	36107997	IL
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	036107997	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487630448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACY A KNIGHT MD

Provider Business Mailing Address
First Line	:	660 N WESTMORELAND RD
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1659
Country	:	US
Telephone Number	:	847-535-6150
Fax Number	:	847-535-7801

Provider Business Practice Location Address
First Line	:	660 N WESTMORELAND RD
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1659
Country	:	US
Telephone Number	:	847-535-6150
Fax Number	:	847-535-7801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	03/12/2014

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Directions to “ LACY A KNIGHT MD” Practice Location

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