Healthcare Provider Details

I. General information

NPI: 1437192408
Provider Name (Legal Business Name): BRIAN J. KNABE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHERRY AVE
PARK FALLS WI
54552-1467
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-3212
  • Fax:
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036092236
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55292
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55292
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: