Individual provider · Type 1 NPI

Leonard William Russo, PA-C

Medical Physician Assistant · Southfield, MI

NPI number 1902905979 Active

Practice location

22255 Greenfield Rd
Southfield, MI 48075-3710

Mailing address

34461 Morningdale Dr
Sterling Heights, MI 48312-5743

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X5601001728 (MI)

Medical Physician Assistant: Definition to come...

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About NPI 1902905979

Leonard William Russo, PA-C's National Provider Identifier is 1902905979, issued on Sep 22, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Southfield, MI. The record was last updated on Jul 8, 2007.