Provider Demographics
NPI:1740661529
Name:LUNDIN, MICHAEL SAUL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SAUL
Last Name:LUNDIN
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:N6074 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-6164
Mailing Address - Country:US
Mailing Address - Phone:248-885-4929
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9551
Practice Address - Country:US
Practice Address - Phone:715-793-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73532-20207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist