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Individual
TIMOTHY MORGAN RUSSO
Active
Individual
TIMOTHY MORGAN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
213.000337
IL
224P00000X
Prosthetist
Primary
211.000298
IL
Other
Enumeration date
02/28/2018
Last updated
02/28/2018
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