Provider Demographics
NPI:1871382242
Name:LUSTBADER, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:LUSTBADER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W WALTON ST APT 1902
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7331
Mailing Address - Country:US
Mailing Address - Phone:847-284-4112
Mailing Address - Fax:
Practice Address - Street 1:9 W WALTON ST APT 1902
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7331
Practice Address - Country:US
Practice Address - Phone:847-284-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program