MEDICARE: DR. DANIEL ELLIOTT ROUSSO 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
1	174400000X	Specialist		AL

General Provider Information

NPI Number	:	1447299987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL ELLIOTT ROUSSO M.D.

Provider Business Mailing Address
First Line	:	2700 HIGHWAY 280 S
Second Line	:	SUITE 300-W
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2420
Country	:	US
Telephone Number	:	205-930-9595
Fax Number	:	205-802-7719

Provider Business Practice Location Address
First Line	:	2700 HIGHWAY 280 S
Second Line	:	SUITE 300-W
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2420
Country	:	US
Telephone Number	:	205-930-9595
Fax Number	:	205-802-7719

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/26/2007

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