Healthcare Provider Details

I. General information

NPI: 1669522082
Provider Name (Legal Business Name): SHELLEY R. KNOWLES, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR SUITE 400
ROCHESTER MI
48307-1871
US

IV. Provider business mailing address

1135 W UNIVERSITY DR SUITE 400
ROCHESTER MI
48307-1871
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-6060
  • Fax: 248-651-6061
Mailing address:
  • Phone: 248-651-6060
  • Fax: 248-651-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number4301066738
License Number StateMI

VIII. Authorized Official

Name: DR. SHELLEY R. KNOWLES
Title or Position: OWNER
Credential: MD
Phone: 248-651-6060