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Individual

DR. DAVID MICHAEL LUSTIG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
13933 17TH ST, SUITE 201, DADE CITY, FL 33525-4604
(352) 437-4505
(352) 437-4709
Mailing address
13933 17TH ST, SUITE 201, DADE CITY, FL 33525-4604
(352) 437-4505
(352) 437-4709

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME 128530
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
007503962
VA
01
0380470
CIGNA
VI
01
2127380
MDIPA
VA
01
340018922
RAILROAD MEDICARE
GA
01
3433588
AETNA
VA
01
434494
ANTHEM
VA
01
542025035
TRICARE
VA
01
7503962
VIRGINIA PREMIER
VA
Enumeration date
10/17/2006
Last updated
02/01/2017
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