Provider Demographics
NPI:1114937711
Name:KNUTSEN, ALAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:PAUL
Last Name:KNUTSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:P
Other - Last Name:KNUTSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-268-4014
Mailing Address - Fax:314-577-5398
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-268-4014
Practice Address - Fax:314-577-5398
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7132208000000X, 2080I0007X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080I0007XAllopathic & Osteopathic PhysiciansPediatricsClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13375Medicare UPIN