Provider Demographics
NPI:1437261047
Name:KNIGHT, REBECCA A (MD, LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5550
Mailing Address - Country:US
Mailing Address - Phone:309-692-0123
Mailing Address - Fax:309-692-0184
Practice Address - Street 1:4300 N BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5550
Practice Address - Country:US
Practice Address - Phone:309-692-0123
Practice Address - Fax:309-692-0184
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00209376Medicare PIN
ILK1249Medicare PIN