Provider Demographics
NPI:1124027651
Name:KNIFFEN, FRANK J (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:KNIFFEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0100
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:6701 159TH ST
Practice Address - Street 2:INGALLS SAME DAY SURGERY
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1758
Practice Address - Country:US
Practice Address - Phone:708-429-0220
Practice Address - Fax:708-915-7400
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036064175207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064175Medicaid
IL036064175Medicaid
IL050022352Medicare PIN
ILL18386Medicare PIN
ILC30741Medicare PIN
IL958870Medicare PIN