Individual
MS. SUSAN MARIE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14500 HALL RD, STERLING HEIGHTS, MI 48313-1229
(800) 653-6568
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 876-9490
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4704189539
MI
363LF0000X
Family Nurse Practitioner
Primary
4704189539
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704189539
FAMILY NURSE PRACTITIONER
MI
05
—
4704189539
—
MI
Enumeration date
05/10/2022
Last updated
12/20/2022
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