MEDICARE: LUMANDA, PA

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	207Q00000X	Family Medicine Physician	PA01218	TX

General Provider Information

NPI Number	:	1215161005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMANDA, PA

Provider Business Mailing Address
First Line	:	4010 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-831-4300
Fax Number	:	817-831-4306

Provider Business Practice Location Address
First Line	:	4010 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-831-4300
Fax Number	:	817-831-4306

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL NJOTU
Credential	:	PA
Telephone Number	:	817-831-4300

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	07/20/2009

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Directions to “LUMANDA, PA ” Practice Location

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