MEDICARE: LILI ANN LUSTIG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34.010086	OH
2	207Q00000X	Family Medicine Physician	OS18030	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669613592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILI ANN LUSTIG D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-3535
Fax Number	:	239-343-4065

Provider Business Practice Location Address
First Line	:	42880 CRESCENT LOOP STE 110
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33982-5062
Country	:	US
Telephone Number	:	239-343-3535
Fax Number	:	239-343-4065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	11/21/2022

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Directions to “ LILI ANN LUSTIG D.O.” Practice Location

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