Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 35.12801 | OH |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 35.12801 | OH |
N | 207NS0135X | Procedural Dermatology | 35.12801 | OH |
NPI | 1447545603 |
---|---|
Provider Name | Dr. Thomas J Knackstedt |
First Address | Cleveland, OH 44109-1900 |
Second Address | Cleveland, OH 44109-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 27/12/2021 |