Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 2013017410 | MO |
NPI | 1053364281 |
---|---|
Provider Name | Matthew C Lundien |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 15/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053364281 | (05) | MO |
198935001 | (05) | AR |
200499740 A | (05) | OK |
201077460A | (05) | KS |
431560263 | TRICARE (01) | MO |
G89812 | (02) | |
P01208067 | RR MCR (01) | MO |