Provider Demographics
NPI:1427093087
Name:LES T. SANDKNOP, D.O. PA
Entity type:Organization
Organization Name:LES T. SANDKNOP, D.O. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LES
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANDKNOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-771-9081
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-1029
Mailing Address - Country:US
Mailing Address - Phone:972-771-9081
Mailing Address - Fax:972-772-7102
Practice Address - Street 1:1005 W RALPH HALL PKWY STE 221
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6662
Practice Address - Country:US
Practice Address - Phone:972-771-9000
Practice Address - Fax:972-771-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00367NOtherMEDICARE GROUP
TX080455101Medicaid