Provider Demographics
NPI:1801909452
Name:LUSTIG, MARY F (AUD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:LUSTIG
Suffix:
Gender:
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:577 MICHIGAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4911
Mailing Address - Country:US
Mailing Address - Phone:616-393-2190
Mailing Address - Fax:616-393-0147
Practice Address - Street 1:399 E 32ND ST STE 70
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5518
Practice Address - Country:US
Practice Address - Phone:616-392-2222
Practice Address - Fax:616-499-7229
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000125237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44060005Medicare PIN