Healthcare Provider Details

I. General information

NPI: 1194776203
Provider Name (Legal Business Name): CYNTHIA KNAPP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7053 TYRRELL RD
LAINGSBURG MI
48848-9805
US

IV. Provider business mailing address

1750 E BELLOWS ST STE. G
MT PLEASANT MI
48858-3872
US

V. Phone/Fax

Practice location:
  • Phone: 517-651-6462
  • Fax:
Mailing address:
  • Phone: 989-773-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301061761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: