Individual
MRS. TRINA MARY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
20967 KELLY RD, EASTPOINTE, MI 48021
(586) 779-8600
(586) 779-2019
Mailing address
39090 GARFIELD RD, STE 108, CLINTON TOWNSHIP, MI 48038-4093
(586) 779-8600
(586) 779-2019
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
TR001571
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2760454
—
MI
01
—
480E020980
BS MICH
MI
01
—
5505057
BS MI
—
Enumeration date
12/23/2005
Last updated
12/29/2016
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