Provider Demographics
NPI:1518210608
Name:TODD M PODKOWKA DO PLLC
Entity Type:Organization
Organization Name:TODD M PODKOWKA DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PODKOWKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-571-8054
Mailing Address - Street 1:6029 STOKES LEE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LEE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13363-2717
Mailing Address - Country:US
Mailing Address - Phone:315-571-8054
Mailing Address - Fax:
Practice Address - Street 1:6029 STOKES LEE CENTER RD
Practice Address - Street 2:
Practice Address - City:LEE CENTER
Practice Address - State:NY
Practice Address - Zip Code:13363-2717
Practice Address - Country:US
Practice Address - Phone:315-571-8054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty