| Organization Name: | LARA S PODUSKA DPM LLC |
| NPI Number: | 1023361318 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID M PODUSKA (GEN PTR) |
| Mailing Address: | 24816 Aurora Rd Ste A Bedford Heights |
| State: | OH US |
| Postal Code: | 441466908 |
| Phone Number: | 2166620027 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2012 |
| NPI Last Update Date: | 10/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |