Individual
TIMOTHY MORGAN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
401 HARRISON ST, OAK PARK, IL 60304-1427
(708) 383-2257
(708) 383-0739
Mailing address
1S376 SUMMIT AVE, CT. E, OAKBROOK TERRACE, IL 60181-3985
(630) 705-4092
(630) 424-0467
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
213.000337
IL
224P00000X
Prosthetist
Primary
211.000298
IL
Other
Enumeration date
02/28/2018
Last updated
02/28/2018
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