Provider Demographics
NPI:1548249519
Name:PALUSKA, GERALD MATHEW (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:MATHEW
Last Name:PALUSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:312 E ALTA VISTA
Mailing Address - Street 2:CENTRAL BILLING OFFICE ATTN REGINA NEWTON
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-684-3053
Mailing Address - Fax:641-683-2855
Practice Address - Street 1:312 E ALTA VISTA
Practice Address - Street 2:ADDICTION MEDICINE CLINIC
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-684-3170
Practice Address - Fax:641-684-3173
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18366207RA0401X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6158311Medicaid
IA06515OtherBCBS
IA7158311Medicaid
IAI16750Medicare PIN
A01381Medicare UPIN