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General NPI Number Information
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NPI Number | 1134107147
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Entity Type | Individual
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Provider Name | LON T KNUDSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 1901 OLD MINNESOTA AVE MANKATO CLINIC @ DANIELS HEALTH CENTER
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City | SAINT PETER
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State | MN
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Zip | 56082-1763
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Country | US
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Telephone | 507-934-2325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8674 MAKATO CLINIC LTD 1230 E. MAIN STREET
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City | MANKATO
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State | MN
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Zip | 56002-8674
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Country | US
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Telephone | 507-625-1811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 26414
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License Number State | MN
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