Provider Demographics
NPI:1659341121
Name:LUNDE, PAULA A (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:LUNDE
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 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-020
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8400
Mailing Address - Fax:269-341-8427
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:STE M020,
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8400
Practice Address - Fax:269-341-8427
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4177995Medicaid
MICN1148OtherRAILROAD MEDICARE
A74331Medicare UPIN
MICN1148OtherRAILROAD MEDICARE