Healthcare Provider Details

I. General information

NPI: 1679578157
Provider Name (Legal Business Name): SCOTT KNUTSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 LYNDALE AVE S STE 105
RICHFIELD MN
55423-2673
US

IV. Provider business mailing address

6625 LYNDALE AVE S STE 300
RICHFIELD MN
55423-2491
US

V. Phone/Fax

Practice location:
  • Phone: 612-788-8778
  • Fax: 612-869-3473
Mailing address:
  • Phone: 612-788-8778
  • Fax: 612-869-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number427
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: