MEDICARE: DR. LARA SUE PODUSKA D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	36002924P	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356346860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARA SUE PODUSKA D.P.M.

Provider Business Mailing Address
First Line	:	24816 AURORA RD
Second Line	:	SUITE A
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24816 AURORA RD
Second Line	:	SUITE A
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1758
Country	:	US
Telephone Number	:	216-662-0027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/09/2023

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