Colvert, Lundy Wade

Colvert, Lundy Wade is an individual health care provider with primary practice located at 4500 Memorial Dr , Belleville IL 62226-5360. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Colvert, Lundy Wade can be contacted via phone (618) 257-5879.

Contact Information

Primary practice address
4500 Memorial Dr Belleville IL 62226-5360
Phone: (618) 257-5879
Fax: (618) 257-6740
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036114113 Illinois
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X E-8137 Arkansas
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X E-8137 Arkansas

Profile Details

NPI number 1225179476
LBN Legal business name Colvert, Lundy Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2007
Last updated May 20th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225179476 NPPES
Illinois Other P00265156 RAILROAD MEDICARE

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