Provider Demographics
NPI:1235125683
Name:KNUDSEN, MARC D (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-951-2541
Mailing Address - Fax:405-951-2237
Practice Address - Street 1:3300 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-951-2541
Practice Address - Fax:405-951-2237
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-04-09
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Provider Licenses
StateLicense IDTaxonomies
OK3859207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100259600AMedicaid
H44730Medicare UPIN
OK100259600AMedicaid