Provider Demographics
NPI:1518901032
Name:KNIGHT, SANFORD I (DPM)
Entity Type:Individual
Prefix:MR
First Name:SANFORD
Middle Name:I
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2124
Mailing Address - Country:US
Mailing Address - Phone:847-612-4729
Mailing Address - Fax:847-835-8003
Practice Address - Street 1:434 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-2124
Practice Address - Country:US
Practice Address - Phone:847-612-4729
Practice Address - Fax:847-835-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000826A213E00000X
IL016-004716213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200160970AMedicaid
IN000000224020OtherANTHEM BCBS INDIANA
IN4840180001OtherDMERC
IL01628296OtherBCBS OF ILLINOIS
MI134297859Medicaid
IN000000224021OtherANTHEM BCBS INDIANA
IL016004716Medicaid
IL480025164OtherRAILROAD MEDICARE
MI4856050000OtherBCBS OF MICHIGAN
IN000000224021OtherANTHEM BCBS INDIANA
IN200160970AMedicaid
MION25870Medicare PIN
IL559980Medicare PIN