Provider Demographics
NPI:1134111909
Name:KNOWER, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:KNOWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-706-6700
Mailing Address - Fax:541-706-5996
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-706-6700
Practice Address - Fax:541-706-5996
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 15601207Q00000X
IDM 5124207Q00000X
OR15601207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218722Medicaid
OR113411909OtherNPI
OR218722Medicaid
OR02940Medicare PIN
P00155021OtherRAILROAD MEDICARE
OR205625Medicaid
009844004OtherBLUECROSS/BLUESHIELD
GRP331OtherPROVIDENCE HEALTH PLANS
C91360Medicare UPIN
ORR106864Medicare ID - Type Unspecified