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NPI Code Detail

MEDICARE: THOMAS J LUSTBERG MD FACS

MEDICARE: THOMAS J LUSTBERG MD FACS
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
12084P0804XChild & Adolescent Psychiatry PhysicianME85868FL

General Provider Information

NPI Number : 1811982531
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS J LUSTBERG MD FACS
Provider Business Mailing Address
First Line : 379 6TH AVE W
Second Line :
City : BRADENTON
State : FL
Zip : 34205-8820
Country : US
Telephone Number : 941-782-4259
Fax Number : 941-782-4101
Provider Business Practice Location Address
First Line : 379 6TH AVE W
Second Line :
City : BRADENTON
State : FL
Zip : 34205-8820
Country : US
Telephone Number : 941-782-4259
Fax Number : 941-782-4101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 07/08/2007

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