Individual
DR. MICHAEL ANTHONY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7000 W PLANO PKWY STE 110, PLANO, TX 75093-8467
(972) 306-3767
(972) 566-8839
Mailing address
7610 N STEMMONS FWY STE 600, DALLAS, TX 75247-4228
(214) 689-5960
(469) 713-8084
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
L2616
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166239701
—
TX
01
—
8DD556
BCBSTX
TX
Enumeration date
04/05/2006
Last updated
09/21/2020
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