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NPI Code Detail

MEDICARE: TIMOTHY MORGAN RUSSO CPO

MEDICARE: TIMOTHY MORGAN RUSSO CPO
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
1222Z00000XOrthotist213.000337IL
2224P00000XProsthetist211.000298IL

General Provider Information

NPI Number : 1992206577
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY MORGAN RUSSO CPO
Provider Business Mailing Address
First Line : 1S376 SUMMIT AVE
Second Line : CT. E
City : OAKBROOK TERRACE
State : IL
Zip : 60181-3985
Country : US
Telephone Number : 630-705-4092
Fax Number : 630-424-0467
Provider Business Practice Location Address
First Line : 401 HARRISON ST
Second Line :
City : OAK PARK
State : IL
Zip : 60304-1427
Country : US
Telephone Number : 708-383-2257
Fax Number : 708-383-0739
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 02/28/2018

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Directions to “ TIMOTHY MORGAN RUSSO CPO” Practice Location

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