Provider Demographics
NPI:1700800422
Name:KNAPP, DAVID K (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:KNAPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1021 KARL GREIMEL DR
Mailing Address - Street 2:SUITE 99
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9465
Mailing Address - Country:US
Mailing Address - Phone:810-225-4589
Mailing Address - Fax:810-220-2050
Practice Address - Street 1:24455 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3933
Practice Address - Country:US
Practice Address - Phone:734-946-8150
Practice Address - Fax:734-946-4849
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDK002533OtherBCBSM LICENSE
MI1158218090OtherBCBSM
MIMI1244001Medicare PIN