Healthcare Provider Details

I. General information

NPI: 1023361318
Provider Name (Legal Business Name): LARA S PODUSKA DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 12/09/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24816 AURORA RD STE A
BEDFORD HEIGHTS OH
44146-6908
US

IV. Provider business mailing address

24816 AURORA RD STE A
BEDFORD HEIGHTS OH
44146-6908
US

V. Phone/Fax

Practice location:
  • Phone: 216-662-0027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID M PODUSKA
Title or Position: GEN PTR
Credential:
Phone: 216-662-0027