Individual
DR. RYAN MATTHEW LUSTIG I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4320 WORNALL RD, SUITE 208, KANSAS CITY, MO 64111-5941
(816) 531-0552
(816) 756-2503
Mailing address
4320 WORNALL RD, SUITE 208, KANSAS CITY, MO 64111-5941
(816) 531-0552
(816) 756-2503
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0434257
KS
207R00000X
Internal Medicine Physician
2009032079
MO
207RN0300X
Nephrology Physician
0434257
KS
207RN0300X
Nephrology Physician
Primary
2009032079
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01096578
RR MEDICARE
MO
Enumeration date
04/23/2007
Last updated
12/12/2012
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