Provider Demographics
NPI:1275859704
Name:KNOLL, ELON (MD)
Entity Type:Individual
Prefix:
First Name:ELON
Middle Name:
Last Name:KNOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25206 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11885 E 12 MILE RD STE 100A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3465
Practice Address - Country:US
Practice Address - Phone:586-576-1615
Practice Address - Fax:586-576-1629
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096937207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology