MEDICARE: BRUCE E LUNDAK 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	208800000X	Urology Physician	20742	NE
2	208800000X	Urology Physician	DR.0070126	CO

General Provider Information

NPI Number	:	1699778787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE E LUNDAK M.D.

Provider Business Mailing Address
First Line	:	2315 E HARMONY RD STE 140
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8620
Country	:	US
Telephone Number	:	970-484-6700
Fax Number	:	970-484-5723

Provider Business Practice Location Address
First Line	:	2315 E HARMONY RD STE 140
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8620
Country	:	US
Telephone Number	:	970-484-6700
Fax Number	:	970-484-5723

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/10/2023

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