Provider Demographics
NPI:1588771901
Name:KNOLLA, MICHELLE S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:S
Last Name:KNOLLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:717 N 190TH PLZ
Practice Address - Street 2:STE. # 1100
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3917
Practice Address - Country:US
Practice Address - Phone:402-815-1700
Practice Address - Fax:402-815-1959
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15015207V00000X
IA22303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588771901Medicaid
NE10026301600Medicaid
NE47068731799Medicaid
NE10026301600Medicaid
NE10026301600Medicaid
NE10026301700Medicaid
E28873Medicare UPIN