Provider Demographics
NPI:1578052817
Name:KNOBLOCH RADIOLOGY LLC
Entity Type:Organization
Organization Name:KNOBLOCH RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOBLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-787-5707
Mailing Address - Street 1:2600 WILLIAMS ISLAND BLVD APT 1106
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5209
Mailing Address - Country:US
Mailing Address - Phone:305-787-5707
Mailing Address - Fax:954-753-7972
Practice Address - Street 1:2600 WILLIAMS ISLAND BLVD APT 1106
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-5209
Practice Address - Country:US
Practice Address - Phone:305-787-5707
Practice Address - Fax:954-753-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME619462085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME61946OtherSTATE LICENCE