MEDICARE: DR. DAMIEN J MCKNIGHT 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	207Q00000X	Family Medicine Physician	036107041	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	:	1871688853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIEN J MCKNIGHT MD

Provider Business Mailing Address
First Line	:	946 N RACINE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4126
Country	:	US
Telephone Number	:	312-733-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 S MILLER ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4207
Country	:	US
Telephone Number	:	312-733-9010
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/24/2015

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