MEDICARE: DAVID ANDREW LUNDGREN

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1477411296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ANDREW LUNDGREN

Provider Business Mailing Address
First Line	:	328 E 238TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 E 238TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1529
Country	:	US
Telephone Number	:	216-477-2984
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ DAVID ANDREW LUNDGREN ” Practice Location

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