Healthcare Provider Details

I. General information

NPI: 1891776100
Provider Name (Legal Business Name): KATHLEEN ROSE KNAPP D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BYRON RD SUITE A
HOWELL MI
48843-1077
US

IV. Provider business mailing address

1320 BYRON RD SUITE A
HOWELL MI
48843-1077
US

V. Phone/Fax

Practice location:
  • Phone: 517-548-9200
  • Fax: 517-548-2689
Mailing address:
  • Phone: 517-548-9200
  • Fax: 517-548-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009252
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: