Provider Demographics
NPI:1457377483
Name:KNAPP, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 228
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-8050
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:2373 64TH ST
Practice Address - Street 2:STE 1200
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315
Practice Address - Country:US
Practice Address - Phone:616-685-3910
Practice Address - Fax:616-685-3923
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063242207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16094091Medicare PIN
OP32930462Medicare PIN