Provider Demographics
NPI:1427676949
Name:KRUSNIAK, LARA SOPHIA (MD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:SOPHIA
Last Name:KRUSNIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3315 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8373
Practice Address - Country:US
Practice Address - Phone:573-882-3818
Practice Address - Fax:573-884-4609
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2025-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2025027336207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine