Provider Demographics
NPI:1952466443
Name:LUSK, RODNEY P (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:P
Last Name:LUSK
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 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:555 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2136
Practice Address - Country:US
Practice Address - Phone:402-498-6540
Practice Address - Fax:402-498-6357
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23183207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1000650Medicaid
NE237122OtherMIDLANDS CHOICE
NE1000587Medicaid
NE100251710-00Medicaid
IA3972901Medicaid
IA5972901Medicaid
IA9972901Medicaid
NE07162OtherBCBS ENT
IA6972901Medicaid
NE1000583Medicaid
IA2972901Medicaid
IA4972901Medicaid
NE07161OtherBCBS BT
IA8972901Medicaid
NE1000588Medicaid
MI104769860Medicaid
IA7972901Medicaid
NE07161OtherBCBS BT
NE237122OtherMIDLANDS CHOICE
MI104769860Medicaid