MEDICARE: DOUGLAS JAMES 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	207Q00000X	Family Medicine Physician	35057368	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841253101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS JAMES KNUTSON MD

Provider Business Mailing Address
First Line	:	PO BOX 183103
Second Line	:	660 ACKERMAN 3RD FLOOR
City	:	COLUMBUS
State	:	OH
Zip	:	43218-3108
Country	:	US
Telephone Number	:	614-293-2150
Fax Number	:	614-293-6479

Provider Business Practice Location Address
First Line	:	2231 NORTH HIGH STREET
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201
Country	:	US
Telephone Number	:	614-293-2700
Fax Number	:	614-293-2720

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/08/2007

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