Provider Demographics
NPI:1629103460
Name:LUSCRI, NATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:LUSCRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 HYLAND GREENS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3934
Mailing Address - Country:US
Mailing Address - Phone:952-993-2400
Mailing Address - Fax:952-993-2560
Practice Address - Street 1:5320 HYLAND GREENS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-3934
Practice Address - Country:US
Practice Address - Phone:952-993-2400
Practice Address - Fax:952-993-2560
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51180208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics