MEDICARE: MS. ROBERTA ANN KNITTLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601003144	MI

General Provider Information

NPI Number	:	1013976968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBERTA ANN KNITTLE PA-C

Provider Business Mailing Address
First Line	:	9650 BLUEWATER DR
Second Line	:
City	:	PINCKNEY
State	:	MI
Zip	:	48169-8419
Country	:	US
Telephone Number	:	810-231-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 GRAND RIVER RD
Second Line	:	URGENT CARE
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9309
Country	:	US
Telephone Number	:	810-844-7511
Fax Number	:	810-844-7512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	12/28/2021

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