MEDICARE: MICHELLE GILLESPIE RUSNAK

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	208000000X	Pediatrics Physician	57.029651	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	57.029651	OH

General Provider Information

NPI Number	:	1326579558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GILLESPIE RUSNAK

Provider Business Mailing Address
First Line	:	241 W 11TH AVE STE 5082
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-2356
Country	:	US
Telephone Number	:	614-247-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1228
Country	:	US
Telephone Number	:	614-247-7701
Fax Number	:

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	11/12/2025

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