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NPI Code Detail

MEDICARE: ROBERT J KNUDSON MD

MEDICARE: ROBERT J KNUDSON 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
1207Q00000XFamily Medicine Physician33094IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128675OTHERIAWELLMARK HEALTH PLAN
2IA01N6OTHERJOHN DEERE HEALTH PLAN

General Provider Information

NPI Number : 1528056207
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT J KNUDSON MD
Provider Business Mailing Address
First Line : 4321 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-1269
Country : US
Telephone Number : 563-421-5315
Fax Number :
Provider Business Practice Location Address
First Line : 4321 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-1269
Country : US
Telephone Number : 563-421-5315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 04/23/2021

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