Healthcare Provider Details

I. General information

NPI: 1881854933
Provider Name (Legal Business Name): GEORGE A LUSTIG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 NW 71ST COURT SUITE 204
TAMARAC FL
33321-2913
US

IV. Provider business mailing address

7710 NW 71ST COURT SUITE 204
TAMARAC FL
33321-2913
US

V. Phone/Fax

Practice location:
  • Phone: 954-724-0099
  • Fax: 954-724-0070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE A LUSTIG
Title or Position: PRES
Credential: MD
Phone: 954-724-0099