MEDICARE: LEIF CHESNUT LUNOE 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	207L00000X	Anesthesiology Physician	6020084-1205	UT

General Provider Information

NPI Number	:	1649449273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIF CHESNUT LUNOE M.D.

Provider Business Mailing Address
First Line	:	3300 PROVIDENCE DR STE 207
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4620
Country	:	US
Telephone Number	:	907-561-0005
Fax Number	:	907-563-9140

Provider Business Practice Location Address
First Line	:	3300 PROVIDENCE DR STE 207
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4620
Country	:	US
Telephone Number	:	907-561-0005
Fax Number	:	907-563-9140

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	06/22/2009

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