Organization
TRI-STATE UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LANE LUSTBADER M.D. (DOCTOR)
(724) 728-4224
Entity
Organization
Contact information
Practice address
16844 SAINT CLAIR AVE, EAST LIVERPOOL, OH 43920-4277
(330) 385-1770
(724) 728-9722
Mailing address
1 PEARTREE WAY, BEAVER, PA 15009-1954
(724) 728-4224
(724) 728-9722
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD031897E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014509850001
—
PA
01
—
CL4084
RR MEDICARE
—
Enumeration date
09/21/2006
Last updated
01/18/2008
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