Healthcare Provider Details

I. General information

NPI: 1932234275
Provider Name (Legal Business Name): JEFFREY MICHAEL LUNDEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 N FRESNO ST SUITE 201
FRESNO CA
93720-2976
US

IV. Provider business mailing address

7033 N FRESNO ST SUITE 201
FRESNO CA
93720-2976
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-5581
  • Fax: 559-435-5583
Mailing address:
  • Phone: 559-435-5581
  • Fax: 559-435-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG71563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: