Individual
DR. LUNDY WADE COLVERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-5879
(618) 257-6740
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036114113
IL
207P00000X
Emergency Medicine Physician
Primary
E-8137
AR
207R00000X
Internal Medicine Physician
E-8137
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00265156
RAILROAD MEDICARE
IL
Enumeration date
02/09/2007
Last updated
05/20/2021
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