Basic Information
| Provider Information | |||||||||
| NPI: | 1134160906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALUSKY | ||||||||
| FirstName: | LANCING | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 SOUTHMOOR CIR NE | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454292451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372936896 | ||||||||
| FaxNumber: | 9372939150 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 SOUTHMOOR CIR NE | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454292451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372936896 | ||||||||
| FaxNumber: | 9372939150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 36-001679 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0258859 | 05 | OH | MEDICAID |