Provider Demographics
NPI:1225223266
Name:LUNDELL, KATHLEEN T (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:LUNDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1100
Mailing Address - Country:US
Mailing Address - Phone:651-628-0098
Mailing Address - Fax:
Practice Address - Street 1:2848 PATTON RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1100
Practice Address - Country:US
Practice Address - Phone:651-628-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16D01LUOtherBCBS
E49270Medicare UPIN