Provider Demographics
NPI:1134160906
Name:MALUSKY, LANCING PAUL (DPM)
Entity type:Individual
Prefix:
First Name:LANCING
Middle Name:PAUL
Last Name:MALUSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOUTHMOOR CIR NE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2451
Mailing Address - Country:US
Mailing Address - Phone:937-293-6896
Mailing Address - Fax:937-293-9150
Practice Address - Street 1:15 SOUTHMOOR CIR NE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2451
Practice Address - Country:US
Practice Address - Phone:937-293-6896
Practice Address - Fax:937-293-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001679213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0258859Medicaid
OH0258859Medicaid
OH0406401Medicare PIN
OHP00372611Medicare PIN