MEDICARE: MR. MAURI G LUNDERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME64728	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033103825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAURI G LUNDERMAN MD

Provider Business Mailing Address
First Line	:	1775 LEWIS TURNER BLVD
Second Line	:	SUITE 102
City	:	FT WALTON BEACH
State	:	FL
Zip	:	32547-1221
Country	:	US
Telephone Number	:	850-864-3232
Fax Number	:	850-864-5220

Provider Business Practice Location Address
First Line	:	1775 LEWIS TURNER BLVD
Second Line	:	SUITE 102
City	:	FT WALTON BEACH
State	:	FL
Zip	:	32547-1221
Country	:	US
Telephone Number	:	850-864-3232
Fax Number	:	850-864-5220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	06/06/2011

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Practice Fax: 850-864-5220

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