Provider Demographics
NPI:1821097775
Name:LUSK, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:LUSK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:700 PARK VISTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8025
Mailing Address - Country:US
Mailing Address - Phone:239-691-0032
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:6101 PINE RIDGE RD # DESK10
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-649-1662
Practice Address - Fax:239-649-7053
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME44001207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51352Medicare UPIN
FL05562Medicare ID - Type Unspecified