Russo, John L

Russo, John L is an individual health care provider with primary practice located at 1025 Marsh St , Mankato MN 56001-4752. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Russo, John L can be contacted via phone (507) 625-4031.

Contact Information

Primary practice address
1025 Marsh St Mankato MN 56001-4752
Phone: (507) 625-4031
Fax: (507) 385-6497
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 48135-020 Wisconsin
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 105790 Minnesota

Profile Details

NPI number 1578592820
LBN Legal business name Russo, John L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2006
Last updated Sep 27th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578592820 NPPES
Wisconsin Other P00247500 MEDICARE RAILROAD
Wisconsin MEDICAID 34676800 MEDICARE RAILROAD
Wisconsin Other 389906599 MEDICARE RAILROAD
Wisconsin Other 389906599001 MEDICARE RAILROAD

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