Provider Demographics
NPI:1952388654
Name:KNAPP, MARY JANET (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANET
Last Name:KNAPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14325 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4593
Mailing Address - Country:US
Mailing Address - Phone:734-427-9222
Mailing Address - Fax:734-427-6316
Practice Address - Street 1:14325 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4593
Practice Address - Country:US
Practice Address - Phone:734-427-9222
Practice Address - Fax:734-427-6316
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114515377Medicaid
MI114515377Medicaid
F03785Medicare UPIN