Individual
RENEE J KNUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3920 ST FRANCIS WAY STE 110, LAFAYETTE, IN 47905-4917
(765) 428-5990
(765) 428-5896
Mailing address
PO BOX 781076, DETROIT, MI 48278-7241
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01045000A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324386
ANTHEM PROVIDER NUMBER
IN
01
—
10783508
CAQH
IN
05
—
200168150
—
IN
01
—
471400091
MEDICARE
IN
01
—
P00192247
MEDICARE RAILROAD NUMBER
IN
Enumeration date
03/16/2006
Last updated
10/09/2023
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