Individual
MICHAEL L LUSTBADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 FIFTH STREET, BEAVER, PA 15009
(724) 775-6500
(724) 775-6755
Mailing address
701 FIFTH STREET, BEAVER, PA 15009
(724) 775-6500
(724) 775-6755
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD031897E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000115067
ANTHEM BC BS
PA
05
—
0794145
—
OH
05
—
0949960
—
OH
01
—
1008649
GATEWAY INDIVIDUAL
PA
01
—
10296
MED PLUS INDIVIDUAL
PA
01
—
105466
BLUE SHEILD PA
PA
01
—
251603474-00
BWC
PA
01
—
251711755
HEALTH AMERICA
PA
01
—
34002813
RAILROAD MEDICARE
PA
05
—
983011-0004
—
PA
01
—
B36620
HEALTH AMERICA UPIN
PA
Enumeration date
04/22/2006
Last updated
04/07/2011
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