Provider Demographics
NPI:1720054539
Name:KNUTSON, BRIAN DENNIS (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DENNIS
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:6701 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2591
Practice Address - Country:US
Practice Address - Phone:605-322-6960
Practice Address - Fax:605-322-6961
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4732207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD27020OtherSANFORD HEALTH PLAN
SD35306OtherMIDLANDS CHOICE
SD9171639OtherDAKOTACARE
SD0040220OtherBLUE CROSS
SD1066411OtherARAZ/ AMERICA'S PPO
MN640047700Medicaid
SD070016845OtherRR MEDICARE
IA1532259Medicaid
SD57108B003OtherWPS TRICARE
SDHP37119OtherHEALTHPARTNERS
MN397A1KNOtherCC SYSTEMS/ BLUE PLUS
NE46022474343Medicaid
SD5900392Medicaid
SD0300192OtherMEDICA
MN397A1KN & 640S0KNOtherBLUE CROSS
SD407211028110OtherPREFERRED ONE
SD9171639OtherDAKOTACARE
MN397A1KN & 640S0KNOtherBLUE CROSS
SDH20125Medicare UPIN