Provider Demographics
NPI:1093812349
Name:LUSIS, ERIKS ANTONS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIKS
Middle Name:ANTONS
Last Name:LUSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIKS
Other - Middle Name:ANTONS
Other - Last Name:LUSIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5943 STADIUM DR
Mailing Address - Street 2:STE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1541 GULL RD
Practice Address - Street 2:STE 200
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1644
Practice Address - Country:US
Practice Address - Phone:269-343-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBB47457852005029309207T00000X
MI4301100410207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery