Provider Demographics
NPI:1992766927
Name:RUSLI, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUSLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1281
Mailing Address - Street 2:CO GOOD SAMARITAN HOSPITAL
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-270-7740
Mailing Address - Fax:717-270-3877
Practice Address - Street 1:4TH & WALNUT STREETS
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-1281
Practice Address - Country:US
Practice Address - Phone:717-270-7740
Practice Address - Fax:717-270-3877
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024263E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01677202OtherCAPITAL BLUE CROSS
PA165657OtherHIGHMARK BLUE SHIELD
PA0013001910001Medicaid
PA165657KAGMedicare PIN
PA165657Medicare ID - Type Unspecified
PA165657OtherHIGHMARK BLUE SHIELD