1083623276 NPI number — CYNTHIA MICHEL KNOWLES DO PA

Table of content: (NPI 1083623276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083623276 NPI number — CYNTHIA MICHEL KNOWLES DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA MICHEL KNOWLES DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083623276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-382-5208
Provider Business Mailing Address Fax Number:
954-382-5338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-382-5208
Provider Business Practice Location Address Fax Number:
954-382-5338
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MICHEL KNOWLES
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-382-5208

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS 7539 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0402112 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1885601012 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232536 . This is a "STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 254754600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 279822 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44486 . This is a "BLUECROSS AND BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5537600 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116005 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 39846 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006803400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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