Provider Demographics
NPI:1538209697
Name:KNIGHT, FREDRICK WILLIUS (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:WILLIUS
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2751 ALBERT L BICKNELL DR
Mailing Address - Street 2:SUITE 5-A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3920
Mailing Address - Country:US
Mailing Address - Phone:318-212-6688
Mailing Address - Fax:318-212-6682
Practice Address - Street 1:2751 ALBERT L BICKNELL DR
Practice Address - Street 2:SUITE 5-A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3920
Practice Address - Country:US
Practice Address - Phone:318-212-6688
Practice Address - Fax:318-212-6682
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-06-24
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Provider Licenses
StateLicense IDTaxonomies
LAMD.0155732086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1908649Medicaid
LAB89419Medicare UPIN
LA1908649Medicaid