Provider Demographics
NPI:1235197377
Name:LUSCOMBE, SUSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:LUSCOMBE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17971 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2578
Mailing Address - Country:US
Mailing Address - Phone:305-931-7995
Mailing Address - Fax:305-931-9599
Practice Address - Street 1:17971 BISCAYNE BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2578
Practice Address - Country:US
Practice Address - Phone:305-931-7995
Practice Address - Fax:305-931-9599
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME34408207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4548853OtherAETNA PPO
FL4939228OtherCIGNA
FL156160471572OtherHUMANA PPO
FL2460010OtherAETNA HMO
FL180027405OtherRAILROAD MEDICARE
FL95484OtherUNITED HEALTHCARE
FL0400333OtherGHI
FL95484OtherBCBS OF FLORIDA
FLD78917OtherVISTA
FL4939228OtherCIGNA
FL95484OtherUNITED HEALTHCARE