Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 18744 | WI |
N | 111NI0900X | Internist | 18744 | WI |
Y | 207RH0003X | Hematology & Oncology | 18744 | WI |
NPI | 1013963792 |
---|---|
Provider Name | Raymond W Knight |
First Address | Kenosha, WI 53143 |
Second Address | Kenosha, WI 53143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30106300 | (05) | WI |
B54220 | (02) |