Provider Demographics
NPI:1942376348
Name:KNAFEL, SUSAN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:KNAFEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1144
Mailing Address - Country:US
Mailing Address - Phone:269-781-3128
Mailing Address - Fax:
Practice Address - Street 1:4299 LAKE ST
Practice Address - Street 2:POB 85
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9109
Practice Address - Country:US
Practice Address - Phone:269-465-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001850363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI.R54366Medicare UPIN