Provider Demographics
NPI:1013212745
Name:KNOX, JILL MARIE-BURTON (PA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE-BURTON
Last Name:KNOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE G02
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-6650
Mailing Address - Fax:517-913-6677
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE G02
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-6650
Practice Address - Fax:517-913-6677
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1068231OtherMCLAREN HEALTH ADVANTAGE
MI9570642OtherAETNA
MI1068231OtherMCLAREN HEALTH PLAN
MI0653304060OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIN61290018Medicare PIN