Provider Demographics
NPI:1285601757
Name:RUSZKOWSKI, LESLEE
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:
Last Name:RUSZKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLEE
Other - Middle Name:
Other - Last Name:RUSZKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:18586 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9799
Mailing Address - Country:US
Mailing Address - Phone:330-938-3333
Mailing Address - Fax:330-938-9375
Practice Address - Street 1:18586 5TH ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609-9799
Practice Address - Country:US
Practice Address - Phone:330-938-3333
Practice Address - Fax:330-938-9375
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003010213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU69451Medicare UPIN