Basic Information
| Provider Information | |||||||||
| NPI: | 1598969644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6308 8TH AVENUE | ||||||||
| Address2: | ATTN: MEDICAL STAFF | ||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531435031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626563313 | ||||||||
| FaxNumber: | 2626535850 | ||||||||
| Practice Location | |||||||||
| Address1: | 9555 76TH ST STE 1200 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT PRAIRIE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531581984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626717300 | ||||||||
| FaxNumber: | 2626717315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 10/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 036113675 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 01064963A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 55540 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1598969644 | 05 | WI | MEDICAID | 200910380 | 05 | IN | MEDICAID |