Provider Demographics
NPI:1932100021
Name:KNUDSON, YUMIKO T (MD)
Entity Type:Individual
Prefix:
First Name:YUMIKO
Middle Name:T
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:433 SEMINOLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3743
Mailing Address - Country:US
Mailing Address - Phone:231-733-7777
Mailing Address - Fax:231-733-7778
Practice Address - Street 1:433 SEMINOLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3743
Practice Address - Country:US
Practice Address - Phone:231-733-7777
Practice Address - Fax:231-733-7778
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067308207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3270672Medicaid
MI3270672Medicaid