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General NPI Number Information
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NPI Number | 1437125580
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Entity Type | Individual
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Provider Name | RUSSELL M FIORELLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 1501 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1732
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Country | US
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Telephone | 773-542-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 26460 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1264
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Country | US
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Telephone | 773-257-2500
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Fax | 773-257-2076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | R4H12
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License Number State | MO
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