Provider Demographics
NPI:1245252600
Name:LUSTIG, WILLIAM F (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:LUSTIG
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 1:3201 MIDDLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4427
Mailing Address - Country:US
Mailing Address - Phone:812-372-8281
Mailing Address - Fax:812-372-4525
Practice Address - Street 1:3201 MIDDLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4427
Practice Address - Country:US
Practice Address - Phone:812-372-8281
Practice Address - Fax:812-372-4525
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028641A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080084365OtherMEDICARE RR
IN000000991451OtherANTHEM PIN
IN100052010Medicaid
080084365OtherMEDICARE RR
IN100052010Medicaid