Russo, Trina Mary
Russo, Trina Mary is an sole proprietor health care provider with primary practice located at 20967 Kelly Rd , Eastpointe MI 48021. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as her primary health care specialty. Russo, Trina Mary can be contacted via phone (586) 779-8600.Contact Information
Primary practice address
20967 Kelly Rd
Eastpointe MI 48021
Phone: (586) 779-8600
Fax: (586) 779-2019
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | TR001571 | Michigan |
Profile Details
| NPI number | 1174500862 |
|---|---|
| LBN Legal business name | Russo, Trina Mary |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 23rd, 2005 |
| Last updated | Dec 29th, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174500862 | NPPES |
| Michigan | MEDICAID | 2760454 | |
| Michigan | Other | 480E020980 | |
| Michigan | Other | 5505057 |
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