Healthcare Provider Details

I. General information

NPI: 1376801704
Provider Name (Legal Business Name): DAVID PAUL LUSTENBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8099 CORNELL RD
CINCINNATI OH
45249-2231
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-3700
  • Fax: 513-793-1019
Mailing address:
  • Phone: 513-354-3700
  • Fax: 513-793-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.133529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: