Provider Demographics
NPI:1609876101
Name:KNYSAK, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:KNYSAK
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 1:360 W BUTTERFIELD RD STE 140
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5025
Mailing Address - Country:US
Mailing Address - Phone:630-574-0460
Mailing Address - Fax:630-574-0470
Practice Address - Street 1:360 W BUTTERFIELD RD STE 140
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5025
Practice Address - Country:US
Practice Address - Phone:630-574-0460
Practice Address - Fax:630-574-0470
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076995207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300350Medicare ID - Type Unspecified
C37469Medicare UPIN