Provider Demographics
NPI:1831289016
Name:NUSBAUM, LYNN M (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 S.W. 62 AVE.
Mailing Address - Street 2:PENT HOUSE A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4721
Mailing Address - Country:US
Mailing Address - Phone:305-665-2223
Mailing Address - Fax:305-663-6783
Practice Address - Street 1:7000 S.W. 62 AVE.
Practice Address - Street 2:PENTHOUSE A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4721
Practice Address - Country:US
Practice Address - Phone:305-665-2223
Practice Address - Fax:305-663-6783
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL454222085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
D84952Medicare UPIN
FL07268ZMedicare ID - Type Unspecified