Healthcare Provider Details

I. General information

NPI: 1255043584
Provider Name (Legal Business Name): MATTHEW E RUSEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 CASEY ST STE B
LORIS SC
29569-2981
US

IV. Provider business mailing address

506 E CHEVES ST STE 202
FLORENCE SC
29506-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number95885
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: