Provider Demographics
NPI:1417920273
Name:LUNSFORD, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 73
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-5644
Mailing Address - Fax:901-516-5654
Practice Address - Street 1:3950 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2591
Practice Address - Country:US
Practice Address - Phone:901-516-5644
Practice Address - Fax:901-516-5654
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN0000026401208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116257Medicaid
TN3090737Medicaid
TN6023310OtherBCBS
TNP01440831OtherRAILROAD MEDICARE
TN103I022817Medicare PIN
TN3090737Medicaid