Healthcare Provider Details

I. General information

NPI: 1952466443
Provider Name (Legal Business Name): RODNEY P LUSK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N 30TH ST
OMAHA NE
68131-2136
US

IV. Provider business mailing address

555 N 30TH ST
OMAHA NE
68131-2136
US

V. Phone/Fax

Practice location:
  • Phone: 402-498-6540
  • Fax: 402-498-6357
Mailing address:
  • Phone: 402-280-8100
  • Fax: 402-280-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number23183
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number23183
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: