Provider Demographics
NPI:1073653465
Name:JO M KNATZ MD PC
Entity Type:Organization
Organization Name:JO M KNATZ MD PC
Other - Org Name:INTEGRATIVE GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-985-1093
Mailing Address - Street 1:4540 E BASELINE RD
Mailing Address - Street 2:UNIT 115
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4613
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:
Practice Address - Street 1:4540 E BASELINE RD
Practice Address - Street 2:UNIT 115
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4613
Practice Address - Country:US
Practice Address - Phone:480-985-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD16756Medicare PIN