Provider Demographics
NPI:1740271964
Name:KNAPP MEDICAL CENTER, LTD.
Entity type:Organization
Organization Name:KNAPP MEDICAL CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:773-890-0800
Mailing Address - Street 1:3303 S HALSTED ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6705
Mailing Address - Country:US
Mailing Address - Phone:773-890-0800
Mailing Address - Fax:773-890-5430
Practice Address - Street 1:3303 S HALSTED ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6705
Practice Address - Country:US
Practice Address - Phone:773-890-0800
Practice Address - Fax:773-890-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-62820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID#