Basic Information
| Provider Information | |||||||||
| NPI: | 1114953031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YUSKA | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 HIGHWAY 59 S | ||||||||
| Address2: | |||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567014331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814747 | ||||||||
| FaxNumber: | 2186832595 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 HIGHWAY 59 S | ||||||||
| Address2: | |||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814747 | ||||||||
| FaxNumber: | 2186832595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 592 | MN | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00Q52YU | 01 | MN | MNBS # | OTHER | 13119 | 05 | MN | MEDICAID | 873116 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | 2700154 | 01 | MN | MEDICA # | OTHER | HP25807 | 01 | MN | HEALTHPARTNERS # | OTHER | 141164 | 01 | MN | UCARE # | OTHER | DA9021015708 | 01 | MN | PREFERRED ONE # | OTHER | DA9071015708 | 01 | MN | PREFERRED ONE # | OTHER | MN200028 | 01 | MN | LHS # | OTHER | 14872 | 01 | MN | NDBS # | OTHER | 2700153 | 01 | MN | MEDICA # | OTHER | 58A09YU | 01 | MN | MNBS # | OTHER | 745316700 | 05 | MN | MEDICAID | 15172 | 01 | MN | NDBS # | OTHER |