Healthcare Provider Details

I. General information

NPI: 1750179313
Provider Name (Legal Business Name): AUSTIN MICHAEL LUNDGREN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST MCHM-DOS-GSR
FORT BLISS TX
79906
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST MCHM-DOS-GSR
FORT BLISS TX
79906
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-0730
  • Fax: 915-742-7889
Mailing address:
  • Phone: 915-742-0730
  • Fax: 915-742-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: