MEDICARE: DR. LORI ANN KNUTSTROM D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016-004332	IL

General Provider Information

NPI Number	:	1295817054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI ANN KNUTSTROM D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 985
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451
Country	:	US
Telephone Number	:	815-325-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 W SEMINARY AVE
Second Line	:
City	:	ONARGA
State	:	IL
Zip	:	60955-1401
Country	:	US
Telephone Number	:	815-268-4840
Fax Number	:	815-268-4845

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	02/27/2024

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Directions to “ DR. LORI ANN KNUTSTROM D.P.M.” Practice Location

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