Provider Demographics
NPI:1699896027
Name:KNOTT, TRACEY LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LYNN
Last Name:KNOTT
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:LIAKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4530 E SHEA BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6042
Mailing Address - Country:US
Mailing Address - Phone:602-264-4834
Mailing Address - Fax:602-254-5178
Practice Address - Street 1:5015 S ARIZONA MILLS CIR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6401
Practice Address - Country:US
Practice Address - Phone:480-539-4000
Practice Address - Fax:480-539-7033
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124716207YX0905X
AZ006517207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ937755Medicaid
IL399980OtherGROUP MEDICARE PTAN