Individual
DR. NICHOLAS JOHN FUSTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 PLEASANT ST STE 514, DES MOINES, IA 50309-1418
(515) 241-8912
(515) 241-8988
Mailing address
1200 PLEASANT ST, DES MOINES, IA 50309-1406
(515) 241-5926
(515) 241-5127
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
39645
IA
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
39645
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175150097
MEDICARE
IA
05
—
1891952552
—
IA
Enumeration date
05/20/2008
Last updated
03/17/2018
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