Healthcare Provider Details

I. General information

NPI: 1316517022
Provider Name (Legal Business Name): MANUELA KNIEP-DIMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11585 E 12 MILE RD
WARREN MI
48093-2645
US

IV. Provider business mailing address

47624 HENNINGS ST
CHESTERFIELD MI
48047-4924
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-0300
  • Fax:
Mailing address:
  • Phone: 586-321-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303035150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: