MEDICARE: NATHAN DANIEL LUNGSTROM DO

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	207P00000X	Emergency Medicine Physician	24777	CA

General Provider Information

NPI Number	:	1265217533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN DANIEL LUNGSTROM DO

Provider Business Mailing Address
First Line	:	1150 N INDIAN CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4872
Country	:	US
Telephone Number	:	760-323-6251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 N INDIAN CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4872
Country	:	US
Telephone Number	:	760-323-6251
Fax Number	:

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

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	02/06/2026

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