MEDICARE: NATALIA I RUSH 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	3154	WI
2	207ZP0101X	Anatomic Pathology Physician	4301114169	MI
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301114169	MI

General Provider Information

NPI Number	:	1891133724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA I RUSH M.D.

Provider Business Mailing Address
First Line	:	2137 MAXWELL RD
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8852
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2137 MAXWELL RD
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8852
Country	:	US
Telephone Number	:	708-712-5755
Fax Number	:

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

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	06/24/2026

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