Provider Demographics
NPI:1427936905
Name:PODUSKA, AMBROSE DAVID
Entity type:Individual
Prefix:MR
First Name:AMBROSE
Middle Name:DAVID
Last Name:PODUSKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35554 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50038-3301
Mailing Address - Country:US
Mailing Address - Phone:319-538-2397
Mailing Address - Fax:
Practice Address - Street 1:8025 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5360
Practice Address - Country:US
Practice Address - Phone:515-271-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program