Provider Demographics
NPI:1659470110
Name:KNIAZ, JOHN L (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:KNIAZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9731 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3616
Mailing Address - Country:US
Mailing Address - Phone:219-922-4900
Mailing Address - Fax:219-836-9922
Practice Address - Street 1:9731 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3616
Practice Address - Country:US
Practice Address - Phone:219-922-4900
Practice Address - Fax:219-836-9922
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000771207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100354640AMedicaid
IL211956OtherMEDICARE PTAN
IN628340OtherMEDICARE PTAN