Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | IL |
NPI | 1326023714 |
---|---|
Provider Name | Dr. John V Knaus |
First Address | Morton Grove, IL 60053-3056 |
Second Address | Morton Grove, IL 60053-3056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45807 | (02) | IL |