Provider Demographics
NPI:1518785088
Name:VICTOR KNUTZEN, MD
Entity type:Organization
Organization Name:VICTOR KNUTZEN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:725-204-8972
Mailing Address - Street 1:313 PILOT RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3524
Mailing Address - Country:US
Mailing Address - Phone:725-204-8972
Mailing Address - Fax:725-204-9612
Practice Address - Street 1:313 PILOT RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3524
Practice Address - Country:US
Practice Address - Phone:725-204-8972
Practice Address - Fax:725-204-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty