Provider Demographics
NPI:1164472700
Name:KNOLLE, MICHAEL K (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:KNOLLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-9668
Mailing Address - Country:US
Mailing Address - Phone:717-864-6418
Mailing Address - Fax:717-276-9047
Practice Address - Street 1:4108 HOLLY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9668
Practice Address - Country:US
Practice Address - Phone:717-864-6418
Practice Address - Fax:717-276-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS19191OtherMEDICAL LICENSE
PAOS013226OtherMEDICAL LICENSE