Healthcare Provider Details

I. General information

NPI: 1720025414
Provider Name (Legal Business Name): DAVID LOWELL KNUTSON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 1ST AVE SE SUITE 200
CEDAR RAPIDS IA
52402-5417
US

IV. Provider business mailing address

1815 1ST AVE SE SUITE 200
CEDAR RAPIDS IA
52402-5417
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-0474
  • Fax: 319-363-2170
Mailing address:
  • Phone: 319-363-0474
  • Fax: 319-363-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number33078
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1962610725
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: