Individual
JOSEPH DONALD RUSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 SHONAT ST, MUSKEGON, MI 49442-5363
(231) 666-4443
Mailing address
1215 FULTON ST E, GRAND RAPIDS, MI 49503-3849
(616) 742-0351
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/26/2022
Last updated
07/26/2022
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