Russo, Martin T

Russo, Martin T is an individual health care provider with primary practice located at 1310 Wisconsin Ave Ste 103 , Grand Haven MI 49417. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Russo, Martin T can be contacted via phone (616) 846-2640.

Contact Information

Primary practice address
1310 Wisconsin Ave Ste 103 Grand Haven MI 49417
Phone: (616) 846-2640
Fax: (616) 846-3110
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 5101014183 Michigan

Profile Details

NPI number 1508876236
LBN Legal business name Russo, Martin T
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 8th, 2006
Last updated Jun 11th, 2018 - about 6 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 1508876236 NPPES
Michigan MEDICAID 4094275

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