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NPI Code Detail

MEDICARE: DR. DANIELLE R. RUSSO M.D.

MEDICARE: DR. DANIELLE R. RUSSO M.D.
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
1207Q00000XFamily Medicine Physician01057584AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346249364
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIELLE R. RUSSO M.D.
Provider Business Mailing Address
First Line : 3245 HEALTH DR STE 100
Second Line :
City : GRANGER
State : IN
Zip : 46530-1380
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2102 N MAIN ST
Second Line :
City : NAPPANEE
State : IN
Zip : 46550-9310
Country : US
Telephone Number : 574-862-2165
Fax Number : 574-862-4112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 05/01/2023

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