Healthcare Provider Details

I. General information

NPI: 1861641581
Provider Name (Legal Business Name): JAMES KNELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST STE 375
PHOENIX AZ
85006-2707
US

IV. Provider business mailing address

1331 N 7TH ST STE 375
PHOENIX AZ
85006-2707
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-0070
  • Fax: 602-307-0080
Mailing address:
  • Phone: 602-307-0070
  • Fax: 602-307-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD60276494
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number60895
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: