MEDICARE: DR. RUSSELL PAUL KNITTEL MD

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	207P00000X	Emergency Medicine Physician	A72017	CA

General Provider Information

NPI Number	:	1861421711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL PAUL KNITTEL MD

Provider Business Mailing Address
First Line	:	1812 ARTESIA BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2906
Country	:	US
Telephone Number	:	310-374-5600
Fax Number	:	310-374-5602

Provider Business Practice Location Address
First Line	:	1812 ARTESIA BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2906
Country	:	US
Telephone Number	:	310-374-5600
Fax Number	:	310-374-5602

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	04/06/2014

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