Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301100410 | MI |
N | 207T00000X | Neurosurgeon | BB47457852005029309 | MO |
NPI | 1093812349 |
---|---|
Provider Name | Dr. Eriks Antons Lusis |
First Address | Kalamazoo, MI 49009-3016 |
Second Address | Kalamazoo, MI 49048-1644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/04/2015 |