Individual
TIMOTHY J MCKNIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14519 DETROIT AVE, LAKEWOOD, OH 44107-4316
(216) 521-4200
Mailing address
PO BOX 951101, CLEVELAND, OH 44193-0005
(440) 879-0081
(440) 879-0084
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35-075112
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000133809
ANTHEM
OH
05
—
2129413
—
OH
Enumeration date
11/21/2005
Last updated
07/08/2011
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