Provider Demographics
NPI:1316151715
Name:KNOTT, MICHAEL ALLEN (MPAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:KNOTT
Suffix:
Gender:M
Credentials:MPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4823
Mailing Address - Country:US
Mailing Address - Phone:910-891-1391
Mailing Address - Fax:910-891-1687
Practice Address - Street 1:605 W CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4823
Practice Address - Country:US
Practice Address - Phone:910-891-1391
Practice Address - Fax:910-891-1687
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP35642Medicare UPIN
NC2752771CMedicare ID - Type Unspecified