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General NPI Number Information
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NPI Number | 1679571855
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Entity Type | Individual
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Provider Name | RICHARD J IARUSSI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 5901 MONCLOVA RD
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City | MAUMEE
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State | OH
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Zip | 43537-1841
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Country | US
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Telephone | 419-893-5911
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Fax | 440-579-0191
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Provider Business Mailing Address
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Address Line | 7757 AUBURN RD STE 15
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City | CONCORD TWP
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State | OH
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Zip | 44077-9604
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Country | US
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Telephone | 440-350-0832
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Fax | 440-579-0191
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01057869
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.050894
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License Number State | OH
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