Individual
TRACY MICHELE LUNDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2800 10TH AVE S STE 2200, MINNEAPOLIS, MN 55407-1311
(612) 767-8370
(612) 767-8376
Mailing address
2800 10TH AVE S STE 2200, MINNEAPOLIS, MN 55407-1311
(612) 767-8370
(612) 767-8376
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
48620
AZ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
63649
MN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
R72261
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63649
MINNESOTA MEDICAL LICENSE
MN
Enumeration date
06/22/2010
Last updated
08/26/2020
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