Provider Demographics
NPI:1477574887
Name:KNOWLAND, MICHAEL NMI (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NMI
Last Name:KNOWLAND
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CLIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6520
Mailing Address - Country:US
Mailing Address - Phone:207-799-8628
Mailing Address - Fax:207-767-6089
Practice Address - Street 1:130 CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6520
Practice Address - Country:US
Practice Address - Phone:207-799-8628
Practice Address - Fax:207-767-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011118207Y00000X
IN10175663A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201311730Medicaid