Provider Demographics
NPI:1710951199
Name:KNAPP, ALEXIA P (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:P
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXIA
Other - Middle Name:M
Other - Last Name:PASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7580
Practice Address - Fax:651-254-7584
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47065207N00000X, 207N00000X
AZ35676207N00000X
IA37288207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34924400Medicaid
AZ126574Medicaid
MN268637600Medicaid
MNP00181097Medicare ID - Type UnspecifiedRAILROAD
AZ111165Medicare ID - Type Unspecified
WI1004Medicare PIN
I11703Medicare UPIN
AZ126574Medicaid