Provider Demographics
NPI:1750438065
Name:LUNDEEN, JAMES MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:LUNDEEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S PACE WEST DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1422
Mailing Address - Country:US
Mailing Address - Phone:209-559-6290
Mailing Address - Fax:
Practice Address - Street 1:230 S SHEPHERD ST
Practice Address - Street 2:SUITE A
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5076
Practice Address - Country:US
Practice Address - Phone:209-559-6290
Practice Address - Fax:209-532-5003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18258208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT182580Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER