Healthcare Provider Details

I. General information

NPI: 1134346166
Provider Name (Legal Business Name): MYLES JULIAN LUSZCZYK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 COMPETITION DR STE 100
BETTENDORF IA
52722-8837
US

IV. Provider business mailing address

5250 COMPETITION DR STE 100
BETTENDORF IA
52722-8837
US

V. Phone/Fax

Practice location:
  • Phone: 563-322-0971
  • Fax: 563-324-0615
Mailing address:
  • Phone: 563-322-0971
  • Fax: 563-324-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4177
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101016646
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036.127232
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036.127232
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4177
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOP60137692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: