MEDICARE: THOMAS J. KNUTSON 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
1	207Q00000X	Family Medicine Physician	25152	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080193662	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467583278	OTHER	WI	OMC NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1851477913	OTHER	WI	CMH NPI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760462352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J. KNUTSON MD

Provider Business Mailing Address
First Line	:	103 1ST ST
Second Line	:
City	:	OCONTO
State	:	WI
Zip	:	54153-1117
Country	:	US
Telephone Number	:	920-835-1144
Fax Number	:	920-835-1145

Provider Business Practice Location Address
First Line	:	103 1ST ST
Second Line	:
City	:	OCONTO
State	:	WI
Zip	:	54153-1117
Country	:	US
Telephone Number	:	920-835-1144
Fax Number	:	920-835-1145

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/18/2013

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Directions to “ THOMAS J. KNUTSON MD” Practice Location

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