Organization
MICHAEL G RUSSO MD A PROFESSIONSL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL G RUSSO MD (PHYSICIAN)
(504) 349-6808
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER BLVD, SUITE S 555, MARRERO, LA 70072-3151
(504) 349-6808
(504) 367-8579
Mailing address
1111 MEDICAL CENTER BLVD, SUITE S 555, MARRERO, LA 70072-3151
(504) 349-6808
(504) 367-8579
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD09346R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1347761
—
LA
Enumeration date
06/04/2008
Last updated
01/27/2009
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