Provider Demographics
NPI:1578535985
Name:LUND, KURT E (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:E
Last Name:LUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 MEAD AVE
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-8503
Mailing Address - Country:US
Mailing Address - Phone:814-664-4542
Mailing Address - Fax:814-664-4556
Practice Address - Street 1:1086 MEAD AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-8503
Practice Address - Country:US
Practice Address - Phone:814-664-4542
Practice Address - Fax:814-664-4556
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050434L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014690650004Medicaid
PAF82399Medicare UPIN
PA059422Medicare PIN