Provider Demographics
NPI:1356010573
Name:MYLES KNUTSON, DPM, LLC
Entity Type:Organization
Organization Name:MYLES KNUTSON, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-635-7742
Mailing Address - Street 1:311 B AVE STE S
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3071
Mailing Address - Country:US
Mailing Address - Phone:035-804-7579
Mailing Address - Fax:503-210-0364
Practice Address - Street 1:311 B AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3071
Practice Address - Country:US
Practice Address - Phone:503-804-7579
Practice Address - Fax:503-210-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty