Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 1339 | NE |
NPI | 1487092086 |
---|---|
Provider Name | Scott William Lundgren |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 13/09/2020 |