Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 3600-2212 | OH |
Y | 222Z00000X | Podiatrist | 3600-2212 | OH |
NPI | 1043217896 |
---|---|
Provider Name | Eugene D Podolsky |
First Address | Sandusky, OH 44871-0378 |
Second Address | Niles, OH 44446-3551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0628593 | (05) | OH |
2104005-000 | (05) | WV |
4080718 | (05) | OH |