Provider Demographics
NPI:1548261340
Name:LUND, STEPHEN B (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:LUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411039
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1039
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22974207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS01674018OtherBCBS KC MO GROUP 01674018
MO10807143OtherBCBS OF KC MO
KS100199870CMedicaid
KS100199870AMedicaid
KS10807123OtherBCBS KC MO
930036543OtherRR MEDICARE GROUP CG8899
MO201966215Medicaid
P00188853OtherRR MEDICARE GROUP DC6712
KSC50973Medicare UPIN
MO201966215Medicaid
KSR976633Medicare PIN