Provider Demographics
NPI:1083681365
Name:KNIGHT, MARIBETH (DO)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 673135
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3135
Mailing Address - Country:US
Mailing Address - Phone:734-464-8300
Mailing Address - Fax:734-464-8301
Practice Address - Street 1:5777 W MAPLE RD STE 140
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2268
Practice Address - Country:US
Practice Address - Phone:248-406-1000
Practice Address - Fax:248-406-1001
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4623015Medicaid
MI4623015Medicaid
N91620013Medicare ID - Type Unspecified