Provider Demographics
NPI:1720064942
Name:MCKNIGHT, DIRK (DO)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 BEECHNUT LN
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1493
Mailing Address - Country:US
Mailing Address - Phone:440-667-7702
Mailing Address - Fax:
Practice Address - Street 1:11300 BEECHNUT LN
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1493
Practice Address - Country:US
Practice Address - Phone:440-667-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5311208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48107Medicare UPIN
WVMC0885038Medicare ID - Type Unspecified
F48107Medicare UPIN