MEDICARE: MS. STEPHANIE AYITA KNUPPENBURG 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	207Q00000X	Family Medicine Physician	4301105575	MI
2	207Q00000X	Family Medicine Physician	54346	AZ
3	390200000X	Student in an Organized Health Care Education/Training Program	4301105575	MI
4	207Q00000X	Family Medicine Physician	ME150156	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962816876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE AYITA KNUPPENBURG MD

Provider Business Mailing Address
First Line	:	1094 MILITARY TRL
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7021
Country	:	US
Telephone Number	:	561-622-6111
Fax Number	:	552-159-9308

Provider Business Practice Location Address
First Line	:	4700 N CONGRESS AVE STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3284
Country	:	US
Telephone Number	:	561-622-6111
Fax Number	:	855-215-9930

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

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	08/09/2021

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Directions to “ MS. STEPHANIE AYITA KNUPPENBURG MD” Practice Location

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