Healthcare Provider Details

I. General information

NPI: 1316019672
Provider Name (Legal Business Name): JUSTIN LUNDGREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 VETERANS MEMORIAL BLVD STE 200
METAIRIE LA
70002-5837
US

IV. Provider business mailing address

PO BOX 952346
ATLANTA GA
31192-2346
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-0141
  • Fax:
Mailing address:
  • Phone: 504-889-7200
  • Fax: 504-889-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number025468
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: