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General NPI Number Information
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NPI Number | 1962654731
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Entity Type | Individual
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Provider Name | JAMES EDGAR LUNDEEN SR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 26 SANDUSKY ST
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City | PLYMOUTH
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State | OH
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Zip | 44865-1113
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Country | US
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Telephone | 419-687-4322
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Fax | 419-687-4323
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Provider Business Mailing Address
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Address Line | 26 SANDUSKY ST
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City | PLYMOUTH
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State | OH
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Zip | 44865-1113
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Country | US
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Telephone | 419-687-4322
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Fax | 419-687-4323
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 35052257
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35052257
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | 35052257
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 35052257
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | 35052257
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License Number State | OH
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