Basic Information
| Provider Information | |||||||||
| NPI: | 1699861070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNELLER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT OF ANESTHESIOLOGY | ||||||||
| Address2: | 3901 RAINBOW BLVD MS 3021 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886670 | ||||||||
| FaxNumber: | 9135883365 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPT OF ANESTHESIOLOGY | ||||||||
| Address2: | 3901 RAINBOW BLVD MS 3021 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886670 | ||||||||
| FaxNumber: | 9135883365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 55416 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 200316710A | 05 | KS | MEDICAID |