Healthcare Provider Details

I. General information

NPI: 1134111909
Provider Name (Legal Business Name): MICHAEL E KNOWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 NE DOCTORS DR SUITE 3
BEND OR
97701-6324
US

IV. Provider business mailing address

2275 NE DOCTORS DR SUITE 3
BEND OR
97701-6324
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-6700
  • Fax: 541-706-5996
Mailing address:
  • Phone: 541-706-6700
  • Fax: 541-706-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 15601
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM 5124
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number15601
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: