MEDICARE: RENEE J KNUTSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01045000A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00192247	OTHER	IN	MEDICARE RAILROAD NUMBER
4	471400091	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10783508	OTHER	IN	CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000324386	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1326017955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE J KNUTSON MD

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-7241
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	3920 ST FRANCIS WAY STE 110
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4917
Country	:	US
Telephone Number	:	765-428-5990
Fax Number	:	765-428-5896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/09/2023

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Directions to “ RENEE J KNUTSON MD” Practice Location

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