Provider Demographics
NPI:1871603043
Name:KUSAR, LARISA STROSS (MD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:STROSS
Last Name:KUSAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 VETERANS DR # 117
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-725-2044
Mailing Address - Fax:612-467-1155
Practice Address - Street 1:1 VETERANS DR # 117
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-725-2044
Practice Address - Fax:612-467-1155
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN44209208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNBK8065826OtherDEA
MNBK8065826OtherDEA