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NPI Code Detail

MEDICARE: DR. THOMAS E. LUNDEEN M.D.

MEDICARE: DR. THOMAS E. LUNDEEN M.D.
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
1207RC0000XCardiovascular Disease PhysicianF5629TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1116375503OTHERTXUNITED HEALTHCARE
2816586OTHERTXBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44341155OTHERTXAETNA
5757621OTHERTXFIRSTHEALTH
693919OTHERTXSWHP
7100347101OTHERTXFIRSTCARE
874178408876712A005OTHERTXTRICARE
9MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174527998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS E. LUNDEEN M.D.
Provider Business Mailing Address
First Line : PO BOX 21327
Second Line :
City : WACO
State : TX
Zip : 76702-1327
Country : US
Telephone Number : 254-399-5400
Fax Number : 254-772-8669
Provider Business Practice Location Address
First Line : 7125 NEW SANGER AVENUE
Second Line : STE A
City : WACO
State : TX
Zip : 76712-4054
Country : US
Telephone Number : 254-399-5400
Fax Number : 254-772-8669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 10/07/2011

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