Russo, Frank

Russo, Frank is an individual health care provider with primary practice located at 6501 N Sheridan Rd , Peoria IL 61614-2932. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Russo, Frank can be contacted via phone (309) 692-8110.

Contact Information

Primary practice address
6501 N Sheridan Rd Peoria IL 61614-2932
Phone: (309) 692-8110
Fax: (309) 692-8673
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036049838 Illinois

Profile Details

NPI number 1669537155
LBN Legal business name Russo, Frank
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2006
Last updated Aug 12th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669537155 NPPES
Illinois MEDICAID 036049838
Illinois Other P00243948
Illinois Other 07215196

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