| Kenji Sudoh, | |
|
400 E 3rd St, Duluth, MN 55805-1951 | |
| (218) 786-8364 | |
| Not Available |
| Full Name | Kenji Sudoh |
|---|---|
| Gender | Male |
| Speciality | Sports Medicine |
| Experience | 23 Years |
| Location | 400 E 3rd St, Duluth, Minnesota |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619996832 | NPI | - | NPPES |
| 532492100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 45872 (Minnesota) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Essentia Health Duluth | Duluth, MN | Hospital |
| Deer River Healthcare Center | Deer river, MN | Hospital |
| St Marys Hospital Superior | Superior, WI | Hospital |
| Essentia Health St Mary's Medical Center | Duluth, MN | Hospital |
| Essentia Health Moose Lake | Moose lake, MN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The Duluth Clinic Ltd | 2567374283 | 957 |
| Polinsky Medical Rehabilitation Center | 0941377360 | 242 |
| Entity Name | The Duluth Clinic Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1902563638 PECOS PAC ID: 2567374283 Enrollment ID: O20031103000229 |
| Entity Name | Deer River Healthcare Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1225049018 PECOS PAC ID: 1850388448 Enrollment ID: O20040427000428 |
| Mailing Address | Practice Location Address |
|---|---|
| Kenji Sudoh, 400 E 3rd St, Duluth, MN 55805-1951 Ph: () - | Kenji Sudoh, 400 E 3rd St, Duluth, MN 55805-1951 Ph: (218) 786-8364 |
Dr. Kylie Elizabeth Kraft, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 330 N 8th Ave E, Duluth, MN 55805 Phone: 218-529-9122 | |
Steven Peter Phillipson, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 4621 E Superior St, Duluth, MN 55804 Phone: 218-786-3550 Fax: 218-525-7487 | |
Dr. Jennifer Lynn Jones, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 330 N 8th Ave E, Duluth, MN 55805 Phone: 221-872-3111 Fax: 218-529-9120 | |
Dr. Eric David Boehmer, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 420 E 1st St, Duluth, MN 55805 Phone: 218-786-8364 | |
Dr. Joseph Christopher Metzger Jr., MD Family Medicine Medicare: May Accept Medicare Assignments Practice Location: 330 N 8th Ave E, Duluth, MN 55805 Phone: 218-529-9122 | |
Ms. Kayla Jean Olds, FNP Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1414 Woodland Ave, Duluth, MN 55803 Phone: 218-302-1000 | |
Dr. Rachel Marie Wilcox, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 330 N 8th Ave E, Duluth, MN 55805 Phone: 218-529-9103 |