MEDICARE: KNIGHT NEUROLOGY LLC

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	261QM2500X	Medical Specialty Clinic/Center

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	:	1629415724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNIGHT NEUROLOGY LLC

Provider Business Mailing Address
First Line	:	211 CORAL SANDS DR STE B
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2749
Country	:	US
Telephone Number	:	321-345-6331
Fax Number	:	321-345-3295

Provider Business Practice Location Address
First Line	:	211 CORAL SANDS DR STE B
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2749
Country	:	US
Telephone Number	:	321-345-6331
Fax Number	:	321-345-3295

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KIMBERLY FIELD
Credential	:
Telephone Number	:	321-345-6331

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	09/01/2020

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Directions to “KNIGHT NEUROLOGY LLC ” Practice Location

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