Provider Demographics
NPI:1770882615
Name:LUSARDI ORTHOPEDICS LLC
Entity type:Organization
Organization Name:LUSARDI ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-1700
Mailing Address - Street 1:13230 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3748
Mailing Address - Country:US
Mailing Address - Phone:772-589-1700
Mailing Address - Fax:
Practice Address - Street 1:13230 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3748
Practice Address - Country:US
Practice Address - Phone:772-589-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74006207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty