Provider Demographics
NPI:1285960211
Name:LUNSFORD, GERALD M (CO)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:M
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1309 SHELDON RD
Mailing Address - Street 2:ORTHOTICS DEPARTMENT
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2404
Mailing Address - Country:US
Mailing Address - Phone:616-847-5365
Mailing Address - Fax:616-847-5294
Practice Address - Street 1:1309 SHELDON RD
Practice Address - Street 2:ORTHOTICS DEPARTMENT
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2404
Practice Address - Country:US
Practice Address - Phone:616-847-5365
Practice Address - Fax:616-847-5294
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ILCO2816222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist