Provider Demographics
NPI:1417919374
Name:KNIGHT, KIM EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:EDWARD
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N SANDUSKY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1180
Mailing Address - Country:US
Mailing Address - Phone:419-483-6267
Mailing Address - Fax:419-483-9204
Practice Address - Street 1:521 N SANDUSKY ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1180
Practice Address - Country:US
Practice Address - Phone:419-483-6267
Practice Address - Fax:419-483-9204
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0591640Medicaid
OHA15995OtherUPIN
34147527500OtherWORKERS COMPENSATION
OH0591640Medicaid