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Individual

DR. ROMOLO HARRIS RUSSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
601 JOHN ST, SUITE M-170, KALAMAZOO, MI 49007-5341
(269) 343-3939
(269) 343-3948
Mailing address
601 JOHN ST, SUITE M-170, KALAMAZOO, MI 49007-5341
(269) 343-3939
(269) 343-3948

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
4301036631
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1403912121
BCBS PIN
MI
01
155407
GREAT LAKES HLTH PLN
01
4325832
AETNA PIN
05
4832089-10
MI
Enumeration date
06/12/2006
Last updated
06/14/2010
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