MEDICARE: DR. MARK ANDREW LUNDBERG 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
1	2083P0901X	Public Health & General Preventive Medicine Physician	G64443	CA

General Provider Information

NPI Number	:	1427195916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANDREW LUNDBERG M.D.

Provider Business Mailing Address
First Line	:	202 MIRA LOMA DR
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95965-3500
Country	:	US
Telephone Number	:	530-538-7581
Fax Number	:	530-538-2165

Provider Business Practice Location Address
First Line	:	78 TABLE MOUNTAIN BLVD
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95965-3578
Country	:	US
Telephone Number	:	530-538-7341
Fax Number	:	530-538-5294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	05/20/2008

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