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1447285424

NPI Code Detail

MEDICARE: DR. JANELL E LUNDGREN M.D.

MEDICARE: DR. JANELL E LUNDGREN 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	207Q00000X	Family Medicine Physician	35.086059	OH
2	2084P0800X	Psychiatry Physician	35.086059	OH
3	2084F0202X	Forensic Psychiatry Physician	248136	NY
4	2084P0800X	Psychiatry Physician	248136	NY
5	207Q00000X	Family Medicine Physician	248136	NY
6	2084F0202X	Forensic Psychiatry Physician	35.86059	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LU4178702	OTHER	OH	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447285424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANELL E LUNDGREN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 19176
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-0176
Country	:	US
Telephone Number	:	513-384-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2602 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-384-1344
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/01/2011

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Directions to “ DR. JANELL E LUNDGREN M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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