Individual
THOMAS J. KNUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
103 1ST ST, OCONTO, WI 54153-1117
(920) 835-1144
(920) 835-1145
Mailing address
103 1ST ST, OCONTO, WI 54153-1117
(920) 835-1144
(920) 835-1145
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25152
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080193662
RAILROAD MEDICARE
WI
05
—
11014110
—
WI
01
—
1467583278
OMC NPI
WI
01
—
1851477913
CMH NPI
WI
05
—
30674900
—
WI
Enumeration date
01/19/2006
Last updated
03/18/2013
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