Provider Demographics
NPI:1174704340
Name:KNUDSEN, HARRY ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALAN
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:DPM
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 1749
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-1749
Mailing Address - Country:US
Mailing Address - Phone:615-406-2298
Mailing Address - Fax:615-376-9891
Practice Address - Street 1:348 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1631
Practice Address - Country:US
Practice Address - Phone:615-406-2298
Practice Address - Fax:615-376-9891
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0434213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT97193Medicare UPIN
TN3352498Medicare PIN