Healthcare Provider Details

I. General information

NPI: 1083630693
Provider Name (Legal Business Name): KETTERING PODIATRY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SOUTHMOOR CIR NE
KETTERING OH
45429-2451
US

IV. Provider business mailing address

15 SOUTHMOOR CIR NE
KETTERING OH
45429-2451
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-6896
  • Fax: 937-293-9150
Mailing address:
  • Phone: 937-293-6896
  • Fax: 937-293-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LANCING P MALUSKY
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 937-293-6896