MICHAEL KNOBELOCH (NPI# 1619396736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619396736 |
| Entity Type | Individual |
| Full Name | MICHAEL KNOBELOCH |
| Credential | PSY.D. |
| Practice Address |
102 W Kenwood Ave Suite 120a Decatur IL 62526-4368 |
| Mailing Address |
Po Box 604 Bloomington IL 61702-0604 |
| Practice Telephone | 3097063190 |
| Practice Fax Number | 3095884115 |
| Mailing Telephone | 3097063190 |
| Mailing Fax Number | 3095884115 |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2016-01-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071009106 | IL | Behavioral Health & Social Service Providers |
| Street Address |
102 W KENWOOD AVE SUITE 120A |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-4368 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376534636 | Jeffrey Bruce Rounds | Specialist/Technologist | 102 W Kenwood Ave, Decatur, IL 62526-4300 | 2005-11-04 |
| 1497277263 | Jonathan Roderick Dutt | Family Medicine | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2017-07-12 |
| 1407376338 | Board of Trustees of Southern Illinois University | Clinic/Center | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2017-06-21 |
| 1992234504 | Nicole Gabriel Tenegra | Family Medicine | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2017-06-07 |
| 1811340979 | Aimen Naeem | Family Medicine | 102 W Kenwood Ave, Suite 100, Decatur, IL 62526-4368 | 2016-07-13 |
| 1528411683 | Hema Patel | Family Medicine | 102 W Kenwood Ave, Suite 100, Decatur, IL 62526-4368 | 2016-07-13 |
| 1578914867 | Deepti Sood | Family Medicine | 102 W Kenwood Ave, Suite 100, Decatur, IL 62526-4368 | 2016-06-28 |
| 1780065730 | Zeerak Qureshi | Family Medicine | 102 W Kenwood Ave, Ste 100, Decatur, IL 62526-4368 | 2015-06-16 |
| 1780076901 | Audra L Trump | Nurse Practitioner | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2015-02-25 |
| 1932464633 | Alicia Koontz | Physical Therapy Assistant | 102 W Kenwood Ave, Decatur, IL 62526-4368 | 2012-07-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386280709 | Imani Psychological Services, Inc | Psychologist | 315 W Ponce De Leon Ave Ste 725, Decatur, GA 30030-2464 | 2019-11-20 |
| 1326513102 | Brittany Denise Baker | Psychologist | 1670 Clairmont Rd Rm 3b250, Decatur, GA 30033-4004 | 2018-10-09 |
| 1194228460 | Amy Elizabeth Wingard | Psychologist | 2366 Harrington Dr, Decatur, GA 30033-4902 | 2018-03-13 |
| 1386016301 | Christopher Awosika | Psychologist | 2848 Vining Ridge Ter, Decatur, GA 30034-7500 | 2015-10-29 |
| 1477976173 | Rhea Gordon Phd LLC | Psychologist | 1439 Mclendon Drive, Decatur, GA 30033-1841 | 2014-01-31 |
| 1093054413 | Life Center Counseling and Resources | Psychologist | 1 W Court Sq, Suite 750, Decatur, GA 30030-2538 | 2013-02-05 |
| 1376896696 | Delia L Lang | Psychologist | 2440 Lawrenceville Hwy Ste 200, Decatur, GA 30033-3267 | 2012-10-24 |
| 1407105703 | Virginia L Goetsch, Ph.d., LLC | Psychologist | 775 Commerce Dr, Suite 903, Decatur, GA 30030-2620 | 2012-08-31 |
| 1801022413 | Lisa Clark Enterprises, Inc | Psychologist | 2785 Lawrenceville Hwy Ste 207, Decatur, GA 30033-2515 | 2009-06-09 |
| 1114196912 | Ausborn Behavioral Care, P.C. | Psychologist | 1456 Mclendon Dr Ste B, Decatur, GA 30033-1848 | 2008-02-26 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.