Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | WA | |
N | 222Z00000X | Podiatrist | WA | |
Y | 224P00000X | Prosthetist | PS00000022 | WA |
NPI | 1487631586 |
---|---|
Provider Name | Mr. Michael Philip Podrasky |
First Address | Puyallup, WA 98372 |
Second Address | Puyallup, WA 98372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9018763 | (05) | WA |