Provider Demographics
NPI:1285606962
Name:RUSSO, FRANK H (DPM)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:H
Last Name:RUSSO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5463
Mailing Address - Country:US
Mailing Address - Phone:630-462-1470
Mailing Address - Fax:630-462-9223
Practice Address - Street 1:200 E WILLOW AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5463
Practice Address - Country:US
Practice Address - Phone:630-462-1470
Practice Address - Fax:630-462-9223
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004808213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU58010Medicare UPIN
IL246630Medicare ID - Type Unspecified
IL1152430001Medicare NSC