# DR. LUCKY LUSTERIO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1609149681
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083A0100X | Aerospace Medicine Physician | 02004069A | IN | — |
| 208D00000X | General Practice Physician | 02004069A | IN | Yes |

## Other

- **Enumeration date:** 02/21/2012
- **Last updated:** 10/10/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02004069A | MEDICAL LICENSE | IN |