Healthcare Provider Details

I. General information

NPI: 1821097775
Provider Name (Legal Business Name): MICHAEL D LUSK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD # DESK10
NAPLES FL
34119-3900
US

IV. Provider business mailing address

700 PARK VISTA RD
WEST JEFFERSON NC
28694-8025
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-1662
  • Fax: 239-649-7053
Mailing address:
  • Phone: 239-691-0032
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME44001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: