Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 125061432 | IL |
Y | 207YP0228X | Pediatric Otolaryngology | 35.136122 | OH |
NPI | 1811242704 |
---|---|
Provider Name | Philip Knollman |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 21/05/2019 |