MEDICARE: JOHN LUNDELL MD

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	L1119	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00750599	OTHER	TX	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8BH386	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8EH562	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1891790143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LUNDELL MD

Provider Business Mailing Address
First Line	:	PO BOX 840853
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0865
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 LBJ FWY STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6524
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:	972-715-9976

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/02/2020

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Directions to “ JOHN LUNDELL MD” Practice Location

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