Provider Demographics
NPI:1982036729
Name:PAUL KNITTEL MD INC
Entity Type:Organization
Organization Name:PAUL KNITTEL MD INC
Other - Org Name:DR PAUL'S IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS-KNITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-378-0876
Mailing Address - Street 1:326 CALLE DE ARBOLES
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6606
Mailing Address - Country:US
Mailing Address - Phone:310-378-0876
Mailing Address - Fax:
Practice Address - Street 1:1812 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2906
Practice Address - Country:US
Practice Address - Phone:310-378-0876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-03
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72047207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty