MEDICARE: DR. INDOLFO ALBERTO LUNA DPM

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	213E00000X	Podiatrist	2021022138	MO

General Provider Information

NPI Number	:	1629560891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDOLFO ALBERTO LUNA DPM

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5710
Country	:	US
Telephone Number	:	314-288-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	3649 PAGE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3807
Country	:	US
Telephone Number	:	314-288-0071
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	07/27/2021

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