Provider Demographics
NPI:1225599012
Name:KNAPP, CLINTON MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:MICHAEL
Last Name:KNAPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W JEFFERSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2140
Mailing Address - Country:US
Mailing Address - Phone:317-736-6133
Mailing Address - Fax:
Practice Address - Street 1:1125 W. JEFFERSON ST
Practice Address - Street 2:1155 BUILDING SUITE 101
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131
Practice Address - Country:US
Practice Address - Phone:317-736-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006318A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine