MEDICARE: ETHAN JAMES KNOWLTON

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	213E00000X	Podiatrist	K54321091039	IL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	2020014411	MO

General Provider Information

NPI Number	:	1134652977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN JAMES KNOWLTON

Provider Business Mailing Address
First Line	:	1010 CARONDELET DR STE 301
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4823
Country	:	US
Telephone Number	:	816-943-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 CARONDELET DR STE 301
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4823
Country	:	US
Telephone Number	:	816-943-1111
Fax Number	:

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

Provider Enumeration Date	:	04/08/2017
Last Update Date	:	05/26/2026

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Directions to “ ETHAN JAMES KNOWLTON ” Practice Location

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