MEDICARE: DR. MARCUS D RUSHING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	125066633	IL
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	125066633	IL
3	2083X0100X	Occupational Medicine Physician	65403	MN
4	390200000X	Student in an Organized Health Care Education/Training Program	125066633	IL
5	2083X0100X	Occupational Medicine Physician	4301509762	MI

General Provider Information

NPI Number	:	1639550312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS D RUSHING M.D.

Provider Business Mailing Address
First Line	:	1144 S DETROIT AVE UNIT 141184
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-8342
Country	:	US
Telephone Number	:	313-473-9321
Fax Number	:	313-557-1957

Provider Business Practice Location Address
First Line	:	2785 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-2003
Country	:	US
Telephone Number	:	313-473-9321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	10/17/2024

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