Provider Demographics
NPI:1497708127
Name:LUSTIG, JAMES V (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:LUSTIG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:ALLERGY AND IMMUNOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6840
Mailing Address - Fax:414-266-6437
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:ALLERGY AND IMMUNOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6840
Practice Address - Fax:414-266-6437
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI46743207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
029906261ZOtherHUMANA
WI1497708127Medicaid
WI1497708127Medicaid
D24504Medicare UPIN
WI680860504Medicare PIN
WI32064 0149Medicare PIN
WI027Q 73-601Medicare PIN