Healthcare Provider Details

I. General information

NPI: 1699861070
Provider Name (Legal Business Name): MICHAEL A KNELLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF ANESTHESIOLOGY 3901 RAINBOW BLVD MS 3021
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

DEPT OF ANESTHESIOLOGY 3901 RAINBOW BLVD MS 3021
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6670
  • Fax: 913-588-3365
Mailing address:
  • Phone: 913-588-6670
  • Fax: 913-588-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55416
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: