Basic Information
| Provider Information | |||||||||
| NPI: | 1720054539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNUTSON | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | DENNIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 S MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571082591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226960 | ||||||||
| FaxNumber: | 6053226961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 4732 | SD | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 27020 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 35306 | 01 | SD | MIDLANDS CHOICE | OTHER | 9171639 | 01 | SD | DAKOTACARE | OTHER | 0040220 | 01 | SD | BLUE CROSS | OTHER | 1066411 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 640047700 | 05 | MN | MEDICAID | 070016845 | 01 | SD | RR MEDICARE | OTHER | 1532259 | 05 | IA | MEDICAID | 57108B003 | 01 | SD | WPS TRICARE | OTHER | HP37119 | 01 | SD | HEALTHPARTNERS | OTHER | 397A1KN | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 46022474343 | 05 | NE | MEDICAID | 5900392 | 05 | SD | MEDICAID | 0300192 | 01 | SD | MEDICA | OTHER | 397A1KN & 640S0KN | 01 | MN | BLUE CROSS | OTHER | 407211028110 | 01 | SD | PREFERRED ONE | OTHER |