Individual
WALTER MIECZYSLAW RUSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL STUDENT
Contact information
Practice address
4711 W MEADOW AVE, STILLWATER, OK 74074-1169
(612) 245-3813
Mailing address
4711 W MEADOW AVE, STILLWATER, OK 74074-1169
(612) 245-3813
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/11/2020
Last updated
11/11/2020
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