Provider Demographics
NPI:1316117310
Name:DAVID LUSTIG DO PC
Entity type:Organization
Organization Name:DAVID LUSTIG DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTIG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-758-7330
Mailing Address - Street 1:13355 E 10 MILE RD
Mailing Address - Street 2:224
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2048
Mailing Address - Country:US
Mailing Address - Phone:586-758-7330
Mailing Address - Fax:586-758-5344
Practice Address - Street 1:13355 E 10 MILE RD
Practice Address - Street 2:224
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:586-758-7330
Practice Address - Fax:586-758-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1385030905OtherBCBS
MI1385024215OtherBCBS