Individual
KELLY P KNUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
46629
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46630597
—
CO
01
—
P00727533
MEDICARE RAILROAD
—
Enumeration date
01/26/2007
Last updated
10/27/2010
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