Provider Demographics
NPI:1427259555
Name:KNUTTINEN, GRACE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:KNUTTINEN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:MARTHA-GRACIA
Other - Middle Name:
Other - Last Name:KNUTTINEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:5777 E MAYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4502
Mailing Address - Country:US
Mailing Address - Phone:480-301-7033
Mailing Address - Fax:
Practice Address - Street 1:5777 E MAYO BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054
Practice Address - Country:US
Practice Address - Phone:480-301-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361113992085R0204X
MN613032085R0204X
AZ505892085R0204X
FLME1292002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology