Healthcare Provider Details

I. General information

NPI: 1942376348
Provider Name (Legal Business Name): SUSAN MARIE KNAFEL P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4299 LAKE ST POB 85
BRIDGMAN MI
49106-9109
US

IV. Provider business mailing address

311 N MADISON ST
MARSHALL MI
49068-1144
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-6221
  • Fax:
Mailing address:
  • Phone: 269-781-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601001850
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: