Provider Demographics
NPI:1497188551
Name:KNOBLOCK, STEVEN DAVID (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DAVID
Last Name:KNOBLOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2018
Mailing Address - Country:US
Mailing Address - Phone:248-770-8748
Mailing Address - Fax:
Practice Address - Street 1:134 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2018
Practice Address - Country:US
Practice Address - Phone:248-770-8748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3401179163W00000X
MI3398916367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3398916OtherNURSE ANESTHETIST SPECIALTY CERTIFICATION