Provider Demographics
NPI:1750366050
Name:LUSSNIG, ERICH (MD)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:
Last Name:LUSSNIG
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:PO BOX 3233
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3233
Mailing Address - Country:US
Mailing Address - Phone:844-584-2194
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2245
Practice Address - Country:US
Practice Address - Phone:615-396-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361167782085R0202X
TN368992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3882790Medicaid
TN3721492Medicaid
H81601Medicare UPIN
TN3721492Medicare ID - Type Unspecified
TN3882790Medicare ID - Type Unspecified
TN3882790Medicaid