Provider Demographics
NPI:1144457581
Name:LUNDEEN, MAX JOSEPH MILLER (PA-C)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:JOSEPH MILLER
Last Name:LUNDEEN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-832-0805
Mailing Address - Fax:952-832-5597
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-832-0805
Practice Address - Fax:952-832-5597
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-09-29
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Provider Licenses
StateLicense IDTaxonomies
MN10585363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10585OtherLICENSE