Provider Demographics
NPI:1386723773
Name:KNUFF, DAVID ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:KNUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:725 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3500
Practice Address - Country:US
Practice Address - Phone:920-431-5650
Practice Address - Fax:920-433-7400
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47715-020207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34954400Medicaid
P00419574OtherRAILROAD MEDICARE
MI1005210952OtherBCBS OF MICHIGAN
MI4996949Medicaid
MI4996949Medicaid
WI000144070Medicare PIN