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NPI Code Detail

MEDICARE: DR. PATRICK JOSEPH LUSTMAN PHD

MEDICARE: DR. PATRICK JOSEPH LUSTMAN PHD
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
1103T00000XPsychologist01053MO

Other Identifiers

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

General Provider Information

NPI Number : 1821046012
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK JOSEPH LUSTMAN PHD
Provider Business Mailing Address
First Line : 660 S EUCLID AVE
Second Line : C B 8134
City : SAINT LOUIS
State : MO
Zip : 63110-1010
Country : US
Telephone Number : 314-286-1700
Fax Number : 314-286-1777
Provider Business Practice Location Address
First Line : 660 S EUCLID AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-1010
Country : US
Telephone Number : 314-286-1700
Fax Number : 314-362-7012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 01/24/2017

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