Individual
MR. RUSSELL M FIORELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608-1732
(773) 542-2000
Mailing address
26460 NETWORK PL, CHICAGO, IL 60673-1264
(773) 257-2500
(773) 257-2076
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
R4H12
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202584017
—
MO
Enumeration date
02/28/2006
Last updated
05/26/2016
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