Provider Demographics
NPI:1902819626
Name:KNAAK, JAY B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:KNAAK
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 1:1400 HWY 71
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649
Mailing Address - Country:US
Mailing Address - Phone:218-283-5503
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649
Practice Address - Country:US
Practice Address - Phone:218-283-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63G38KNOtherBCBS
MN093817300Medicaid
MNP00247608Medicare PIN