Provider Demographics
NPI:1043531437
Name:KNUTSON, CRYSTAL J (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:J
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1415 SAINT FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3374
Mailing Address - Country:US
Mailing Address - Phone:952-993-7750
Mailing Address - Fax:952-993-7835
Practice Address - Street 1:1415 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-993-7750
Practice Address - Fax:952-993-7835
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics