Individual
PAUL LUNDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13359 ISLE DR, SUITE 3, BAXTER, MN 56425-2222
(218) 454-7546
Mailing address
13359 ISLE DR, SUITE 3, BAXTER, MN 56425-2222
(218) 454-7546
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
45453
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
741720900
—
MN
Enumeration date
12/02/2005
Last updated
06/12/2024
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