Provider Demographics
NPI:1760436067
Name:KNIGHT, RICARDO ALFONZO (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ALFONZO
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 EXECUTIVE PARKWAY SUITE M4
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:847-305-1954
Mailing Address - Fax:815-381-8665
Practice Address - Street 1:345 EXECUTIVE PARKWAY UNIT M4
Practice Address - Street 2:
Practice Address - City:ROC
Practice Address - State:IL
Practice Address - Zip Code:61107-2474
Practice Address - Country:US
Practice Address - Phone:847-305-1954
Practice Address - Fax:815-381-8665
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110166208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110166Medicaid
IL1902014285OtherCORPORATE NPI- INTEGRATIVE REHABMEDICINE S.C.