Provider Demographics
NPI:1720025414
Name:KNUTSON, DAVID LOWELL II (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LOWELL
Last Name:KNUTSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 1ST AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5417
Mailing Address - Country:US
Mailing Address - Phone:319-363-0474
Mailing Address - Fax:319-363-2170
Practice Address - Street 1:1815 1ST AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5417
Practice Address - Country:US
Practice Address - Phone:319-363-0474
Practice Address - Fax:319-363-2170
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33078207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1962610725Medicaid
IA1962610725Medicaid
IAH05910Medicare UPIN