Active NPI
Michael David Bouknight, DO
- Pain Medicine Physician
- East Norriton, PA
National Provider Identifier
1629670302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine Physician
- License
- MD067370Y
- Practice address
- 3012 Butchers LN
East Norriton, PA 19401-1516 - Phone
- (402) 204-1517
- NPI assigned
- Nov 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine Physician | 208VP0000X | MD067370Y | PA | Primary |
Addresses
Primary practice location
3012 Butchers LN
East Norriton, PA 19401-1516
Mailing address
3012 Butchers LN
East Norriton, PA 19401-1516
Phone (610) 506-3979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD067370Y | PA | MD | Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1629670302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3012 BUTCHERS LN",
"city": "EAST NORRITON",
"state": "PA",
"postal_code": "194011516",
"telephone_number": "610-506-3979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3012 BUTCHERS LN",
"city": "EAST NORRITON",
"state": "PA",
"postal_code": "194011516",
"telephone_number": "402-204-1517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUKNIGHT",
"first_name": "MICHAEL",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Pain Medicine",
"state": "PA",
"license": "MD067370Y",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Norriton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.