MEDICARE: WILLIAM J KNOFLICEK PH.D.

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	103T00000X	Psychologist	461	SD

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
2	4993504	OTHER	SD	WELLMARK BCBS
3	9236559	OTHER	SD	DAKOTACARE PROV #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	99GO9KN	OTHER	MN	MN BLUE CROSS PROV #

General Provider Information

NPI Number	:	1629130075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J KNOFLICEK PH.D.

Provider Business Mailing Address
First Line	:	2400 S. MINNESOTA AVE
Second Line	:	STE 100
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-3762
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	4400 W 69TH ST
Second Line	:	STE. 500
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8171
Country	:	US
Telephone Number	:	605-322-7580
Fax Number	:	605-322-7579

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/18/2015

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Directions to “ WILLIAM J KNOFLICEK PH.D.” Practice Location

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