Provider Demographics
NPI:1255447470
Name:LUSSKY, DONALD H (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:LUSSKY
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 1:1200 S YORK ST STE 3280
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5638
Mailing Address - Country:US
Mailing Address - Phone:331-221-9095
Mailing Address - Fax:630-530-4557
Practice Address - Street 1:1200 S YORK ST STE 3280
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5638
Practice Address - Country:US
Practice Address - Phone:331-221-9095
Practice Address - Fax:630-530-4557
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0832472084N0400X
IL0360832472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-083247Medicaid
ILL18453Medicare PIN