Provider Demographics
NPI:1598732489
Name:KNABEL, MARK RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAYMOND
Last Name:KNABEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 DELHI ST STE 4100
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6362
Mailing Address - Country:US
Mailing Address - Phone:563-557-5900
Mailing Address - Fax:563-557-5905
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:STE 4100
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6358
Practice Address - Country:US
Practice Address - Phone:563-557-5900
Practice Address - Fax:563-557-5905
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22086174400000X
WI24706-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0263558Medicaid
IA1598732489OtherNPI
IA386682104OtherILLINOIS PUBLIC AID
IA421462387OtherMISCELLANEOUS INSURANCE
IA13070OtherDEAN HEALTHCARE
IAIA0107OtherJOHN DEERE HEALTHCARE
IA55736OtherWELLMARK BCBS NUMBER
IA55736OtherWELLMARK BCBS NUMBER
IA386682104OtherILLINOIS PUBLIC AID