Individual
DR. SCOTT S RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E BELTLINE AVE NE, SUITE 301, GRAND RAPIDS, MI 49525-6049
(616) 459-7101
(616) 942-6879
Mailing address
1111 LEFFINGWELL AVE NE, SUITE 300, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 942-6879
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
4301405099
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4761530
—
MI
Enumeration date
10/10/2005
Last updated
02/04/2013
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