Provider Demographics
NPI:1366469884
Name:RANDAL KNATT, CHERYL D (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:RANDAL KNATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:D
Other - Last Name:RANDAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6821 FOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1046
Mailing Address - Country:US
Mailing Address - Phone:337-280-8648
Mailing Address - Fax:
Practice Address - Street 1:6821 FOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1046
Practice Address - Country:US
Practice Address - Phone:337-280-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14973R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4F358Medicare ID - Type Unspecified
H91014Medicare UPIN
LA1169013Medicare ID - Type Unspecified