| Doctor Name: | DR. BRENT KNUDSON |
| NPI Number: | 1982917399 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O |
| License Number: | 01927 |
| Business Practice Address: | 50 N Perry St Pontiac, MI - 483422217 |
| Business Phone Number: | 2483385392 |
| Business Fax Number: | |
| Mailing Address: | 50 N Perry St, PONTIAC |
| State: | MI |
| Postal Code: | 483422217 |
| Phone Number: | 2483385392 |
| Fax Number: | |
| NPI Enumeration Date: | 07/15/2010 |
| NPI Last Update Date: | 05/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 01927 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |