Provider Demographics
NPI:1932371358
Name:KNACKSTEDT, ELIZABETH DOBY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DOBY
Last Name:KNACKSTEDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DOBY
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 581289
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1289
Mailing Address - Country:US
Mailing Address - Phone:801-581-6791
Mailing Address - Fax:801-585-3789
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-581-6791
Practice Address - Fax:801-585-3789
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6851468-12052080P0208X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics