Provider Demographics
NPI:1053304709
Name:KNAPEK, RICHARD M (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:KNAPEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5255 E STOP 11 RD
Mailing Address - Street 2:STE 430
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6340
Mailing Address - Country:US
Mailing Address - Phone:317-889-7906
Mailing Address - Fax:317-889-7908
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:STE 430
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6340
Practice Address - Country:US
Practice Address - Phone:317-889-7906
Practice Address - Fax:317-889-7908
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01023453A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B28288Medicare UPIN
076800Medicare ID - Type Unspecified