Provider Demographics
NPI:1407830102
Name:LUSCHEN, MICHELLE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:C
Last Name:LUSCHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 25TH AVE N STE 1204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1620
Mailing Address - Country:US
Mailing Address - Phone:615-312-0600
Mailing Address - Fax:615-320-3259
Practice Address - Street 1:210 25TH AVE N STE 1204
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1620
Practice Address - Country:US
Practice Address - Phone:615-312-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY475332085R0204X, 2085R0202X
TN279252085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3836103Medicaid
TN3721492Medicaid
TN3718587Medicaid
TN3721492Medicare ID - Type Unspecified
TN3718587Medicare ID - Type UnspecifiedTNONC GROUP
TN3791068Medicare ID - Type Unspecified
TN3791068Medicare ID - Type UnspecifiedIANP
TN3791307Medicare ID - Type UnspecifiedSMRI
TN3718587Medicaid
TN3721492Medicaid
TN3836104Medicare ID - Type Unspecified