Provider Demographics
NPI:1487940672
Name:LUSARDI, JONATHAN JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JEROME
Last Name:LUSARDI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12255 DEPAUL DR SUITE 830N
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-291-5307
Mailing Address - Fax:314-291-0838
Practice Address - Street 1:12255 DEPAUL DR 830N
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-291-5307
Practice Address - Fax:314-291-0838
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2021-04-27
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Provider Licenses
StateLicense IDTaxonomies
MO2016009655207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology