Provider Demographics
NPI:1396171641
Name:RUSLI, ERWIN (MD)
Entity type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:
Last Name:RUSLI
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 1:100 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1530
Mailing Address - Country:US
Mailing Address - Phone:914-493-6000
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W STE 2200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4689
Practice Address - Country:US
Practice Address - Phone:941-794-5621
Practice Address - Fax:941-761-1532
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1309552086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery