Healthcare Provider Details

I. General information

NPI: 1477574887
Provider Name (Legal Business Name): MICHAEL NMI KNOWLAND MD,FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CLIFFORD ST
SOUTH PORTLAND ME
04106-6520
US

IV. Provider business mailing address

130 CLIFFORD ST
SOUTH PORTLAND ME
04106-6520
US

V. Phone/Fax

Practice location:
  • Phone: 207-799-8628
  • Fax: 207-767-6089
Mailing address:
  • Phone: 207-799-8628
  • Fax: 207-767-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10175663A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number011118
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: