Provider Demographics
NPI:1669448387
Name:KNUTSON, DENNIS D (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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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 1:116 W. 69TH ST., STE. 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
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:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD2076207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD407211028109OtherPREFERRED ONE
SD5900083Medicaid
SD2076OtherDAKOTACARE
SD27011OtherSANFORD HEALTH PLAN
SDHP13713OtherHEALTHPARTNERS
SD0040221OtherBLUE CROSS
SD10104OtherMIDLANDS CHOICE
MN397S0KNOtherBLUE CROSS
MN397S0KNOtherCC SYSTEMS/ BLUE PLUS
NE46022474343Medicaid
SD57108B002OtherWPS TRICARE
SD21102OtherARAZ/ AMERICA'S PPO
IA2926428Medicaid
SD0300204OtherMEDICA
SD57108B002OtherWPS TRICARE
MN397S0KNOtherCC SYSTEMS/ BLUE PLUS