Provider Demographics
NPI:1700825296
Name:KNIBBE, JEFFRY D (MD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:D
Last Name:KNIBBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2093 HEALTH DR SW STE 200
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9691
Mailing Address - Country:US
Mailing Address - Phone:616-459-3158
Mailing Address - Fax:616-988-0071
Practice Address - Street 1:2093 HEALTH DR SW STE 200
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-459-3158
Practice Address - Fax:616-819-2222
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70604Medicare UPIN
MIM74460188Medicare PIN