Individual
SCOTT M RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1215 E MICHIGAN AVE, LANSING, MI 48912-1811
(517) 364-2223
(517) 364-3131
Mailing address
PO BOX 634280, CINCINNATI, OH 45263-0041
(517) 336-8080
(517) 336-9122
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
014959
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245322023
BLUE CROSS BLUE SHIELD
MI
01
—
200000002778
PHP & PHPFC
MI
05
—
4929919
—
MI
Enumeration date
09/29/2006
Last updated
12/26/2007
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