Individual
DAVID H RUSTOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
261 MACK AVE STE 188, DETROIT, MI 48201-2417
(313) 745-4600
(313) 745-1165
Mailing address
261 MACK AVE, SUITE 188, DETROIT, MI 48201
(313) 745-4600
(313) 745-1165
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301101540
MI
208100000X
Physical Medicine & Rehabilitation Physician
4301101540
MI
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
4301101540
MI
Other
Enumeration date
07/02/2012
Last updated
03/17/2018
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