MEDICARE: DR. MICHAEL LOYD RUSS MD

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	208100000X	Physical Medicine & Rehabilitation Physician	188435	NY

General Provider Information

NPI Number	:	1235158601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LOYD RUSS MD

Provider Business Mailing Address
First Line	:	30 HEMPSTEAD AVE
Second Line	:	SUITE 258
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-4033
Country	:	US
Telephone Number	:	516-536-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5441 N UNIVERSITY DR STE 101
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4640
Country	:	US
Telephone Number	:	954-803-9002
Fax Number	:	954-933-2305

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/13/2022

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