MEDICARE: KEVIN ATTESTATION FORM - K KNAPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1548115058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ATTESTATION FORM - K KNAPP

Provider Business Mailing Address
First Line	:	1632 STONE ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602
Country	:	US
Telephone Number	:	989-583-6595
Fax Number	:

Provider Business Practice Location Address
First Line	:	22101 MOROSS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48236-2148
Country	:	US
Telephone Number	:	313-343-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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