Basic Information
Provider Information
NPI: 1245271782
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNIERIM
FirstName: DAVID
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9300 VALLEY CHILDRENS PL
Address2:  
City: MADERA
State: CA
PostalCode: 936388761
CountryCode: US
TelephoneNumber: 5593536277
FaxNumber: 5593535424
Practice Location
Address1: 9300 VALLEY CHILDRENS PL
Address2:  
City: MADERA
State: CA
PostalCode: 936388761
CountryCode: US
TelephoneNumber: 5593536277
FaxNumber: 5593535424
Other Information
ProviderEnumerationDate: 06/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000XG40099CAY Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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