Healthcare Provider Details

I. General information

NPI: 1831129949
Provider Name (Legal Business Name): JAMES KNIGHT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 N EUCLID AVE
BAY CITY MI
48706-1148
US

IV. Provider business mailing address

1003 WOODSIDE AVE
ESSEXVILLE MI
48732-1234
US

V. Phone/Fax

Practice location:
  • Phone: 989-684-8203
  • Fax: 989-684-8203
Mailing address:
  • Phone: 989-892-7722
  • Fax: 989-892-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: