Provider Demographics
NPI:1871688853
Name:MCKNIGHT, DAMIEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:J
Last Name:MCKNIGHT
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 1:946 N RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4126
Mailing Address - Country:US
Mailing Address - Phone:312-733-9010
Mailing Address - Fax:
Practice Address - Street 1:822 S MILLER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4207
Practice Address - Country:US
Practice Address - Phone:312-733-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107041Medicaid
IL036107041Medicaid
ILK03833Medicare ID - Type Unspecified