Provider Demographics
NPI:1386731065
Name:KNECHT, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:KNECHT
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 1:511 E. ELM AVE.
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:LINTON
Mailing Address - State:ND
Mailing Address - Zip Code:58552
Mailing Address - Country:US
Mailing Address - Phone:701-254-4531
Mailing Address - Fax:701-254-5459
Practice Address - Street 1:511 E. ELM AVE.
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:ND
Practice Address - Zip Code:58552
Practice Address - Country:US
Practice Address - Phone:701-254-4531
Practice Address - Fax:701-254-5459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2477207Q00000X
ND12588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5340260Medicaid
SD5340260Medicaid