Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036.127232 | IL |
Y | 207X00000X | Orthopaedic Surgeon | 4177 | IA |
N | 207X00000X | Orthopaedic Surgeon | 5101016646 | MI |
N | 207XS0117X | Orthopaedic Spine Surgeon | 036.127232 | IL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 4177 | IA |
N | 207XS0117X | Orthopaedic Spine Surgeon | OP60137692 | WA |
NPI | 1134346166 |
---|---|
Provider Name | Dr. Myles Julian Luszczyk |
First Address | Bettendorf, IA 52722-7564 |
Second Address | Bettendorf, IA 52722-7564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 18/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134346166 | (05) | IA |
209395017 | MEDICARE PTAN (01) | IL |
578210010 | MEDICARE PTAN (01) | IA |