Provider Demographics
NPI:1073352209
Name:TUSHAR, LIBAN
Entity type:Individual
Prefix:
First Name:LIBAN
Middle Name:
Last Name:TUSHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-2187
Mailing Address - Country:US
Mailing Address - Phone:612-924-5410
Mailing Address - Fax:
Practice Address - Street 1:1926 E 86TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-2187
Practice Address - Country:US
Practice Address - Phone:612-924-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program