Provider Demographics
NPI:1134107147
Name:KNUDSON, LON T (MD)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:T
Last Name:KNUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:MAKATO CLINIC LTD 1230 E. MAIN STREET
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1901 OLD MINNESOTA AVE
Practice Address - Street 2:MANKATO CLINIC @ DANIELS HEALTH CENTER
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1763
Practice Address - Country:US
Practice Address - Phone:507-934-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA2951023843OtherPREFERRED ONE
MN1443257OtherAMERICAS PPO
MN53202KNOtherBC BS
IA938134Medicaid
MN1202175OtherU CARE
370005386OtherRR MEDICARE
410849339 56001 C058OtherCHAMPUS
MN044003500Medicaid
MNHP25600OtherHEALTH PARTNERS
MN044003500Medicaid
IA938134Medicaid