Provider Demographics
NPI:1891597050
Name:LUNGMD, PA
Entity type:Organization
Organization Name:LUNGMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD FCCP
Authorized Official - Phone:248-228-0036
Mailing Address - Street 1:5260 HOMELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8467
Mailing Address - Country:US
Mailing Address - Phone:248-228-0036
Mailing Address - Fax:561-257-0227
Practice Address - Street 1:4469 S CONGRESS AVE STE 106
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4726
Practice Address - Country:US
Practice Address - Phone:561-954-2731
Practice Address - Fax:561-257-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty