Individual
MICHELLE L DERUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6621 FANNIN ST, HOUSTON, TX 77030-2399
(512) 789-5167
Mailing address
6621 FANNIN ST, HOUSTON, TX 77030-2399
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
227262
NC
Other
Enumeration date
04/14/2017
Last updated
09/15/2023
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