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General NPI Number Information
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NPI Number | 1063703296
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Entity Type | Organization
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Legal Business Name | LUSICH ANESTHESIA CONSULTANTS
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 313 W ANN ST
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City | CARSON CITY
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State | NV
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Zip | 89703-3903
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Country | US
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Telephone | 775-883-2200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4556
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City | CARSON CITY
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State | NV
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Zip | 89702-4556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER LUSICH
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Credential | MD
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Telephone | 775-315-1384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 11770
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License Number State | NV
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