Individual
MR. WAYNE S. KNESEBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.C.
Contact information
Practice address
4200 PARK AVE, 3RD FLOOR, ASHTABULA, OH 44004-6887
(440) 992-2121
(440) 992-5974
Mailing address
4200 PARK AVE, 3RD FLOOR, ASHTABULA, OH 44004-6887
(440) 992-2121
(440) 992-5974
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OHIO LIC C0501083
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851352959
GROUP NPI NUMBER
OH
Enumeration date
06/18/2007
Last updated
07/08/2007
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