Provider Demographics
NPI:1396819322
Name:LUNDBLAD, LYLE E (DO)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:E
Last Name:LUNDBLAD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6600 FRANCE AVENUE SOUTH
Mailing Address - Street 2:SUITE 660
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-922-2000
Mailing Address - Fax:952-920-7759
Practice Address - Street 1:6600 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 660
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-922-2000
Practice Address - Fax:952-920-7759
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN35744208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN02T31LUOtherBCBS
F28494Medicare UPIN