Provider Demographics
NPI:1891776100
Name:KNAPP, KATHLEEN ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ROSE
Last Name:KNAPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1320 BYRON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1077
Mailing Address - Country:US
Mailing Address - Phone:517-548-9200
Mailing Address - Fax:517-548-2689
Practice Address - Street 1:1320 BYRON RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1077
Practice Address - Country:US
Practice Address - Phone:517-548-9200
Practice Address - Fax:517-548-2689
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2021-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI009252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1843383Medicaid
MI1843383Medicaid
MIE26246Medicare UPIN