Healthcare Provider Details

I. General information

NPI: 1245252600
Provider Name (Legal Business Name): WILLIAM F LUSTIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MIDDLE DR
COLUMBUS IN
47203-4427
US

IV. Provider business mailing address

3201 MIDDLE DR
COLUMBUS IN
47203-4427
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8281
  • Fax: 812-372-4525
Mailing address:
  • Phone: 812-372-8281
  • Fax: 812-372-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01028641A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: