Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 108559 | MO |
Y | 207R00000X | Internist | 108559 | MO |
Y | 111NI0900X | Internist | 108559 | MO |
N | 207RG0300X | Geriatric Medicine | 108559 | MO |
NPI | 1336147602 |
---|---|
Provider Name | Dennis M Knapik JR. |
First Address | Saint Louis, MO 63116-1611 |
Second Address | Saint Louis, MO 63141-8232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 11/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203859707 | (05) | MO |