MARTIN T RUSSO JR. (NPI# 1508876236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508876236 |
| Entity Type | Individual |
| Full Name | MARTIN T RUSSO JR. |
| Credential | DO |
| Practice Address |
1310 Wisconsin Ave Ste 103 Grand Haven MI 49417 |
| Mailing Address |
1310 Wisconsin Ave Ste 101 Grand Haven MI 49417-2472 |
| Practice Telephone | 6168462640 |
| Practice Fax Number | 6168463110 |
| Mailing Telephone | 6168475604 |
| Mailing Fax Number | 6168460141 |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 5101014183 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4094275 | 05 |
| Street Address |
1310 WISCONSIN AVE STE 103 |
| City | GRAND HAVEN |
| State | MI |
| Zip Code | 49417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295393478 | Compassionate Christian Therapy, LLC | Social Worker | 16989 Robbins Rd, Grand Haven, MI 49417 | 2019-06-03 |
| 1275098501 | Christi Rene Fortenbacher | Massage Therapist | 318 S. Beacon Blvd, Grand Haven, MI 49417 | 2019-01-31 |
| 1518440650 | Jessica Hankins | Physical Therapy Assistant | 15773 Charles Ct, Grand Haven, MI 49417 | 2018-09-14 |
| 1558857466 | Christina Steege | Physical Therapist | 514 Friant St, Grand Haven, MI 49417 | 2018-07-03 |
| 1851822548 | Forefront Dermatology, S.c. | Dermatology | 1600 S Beacon Blvd, Suite 160, Grand Haven, MI 49417 | 2017-03-23 |
| 1982057907 | Jeremyn Duane Wiersma | Counselor | 1703 S. Despelder St., Grand Haven, MI 49417 | 2016-07-14 |
| 1760855225 | Lisa Costello | Dental Hygienist | 326 N. Ferry St, Grand Haven, MI 49417 | 2015-11-05 |
| 1508116088 | Great Lakes Chiropractic Health | Chiropractor | 15 S. Seventh St., Grand Haven, MI 49417 | 2012-09-12 |
| 1508120122 | Jonathan Stewart Rouwhorst | Family Medicine | 15161 Willowwood Ct, Grand Haven, MI 49417 | 2012-06-28 |
| 1104108836 | Employee Assistance Center Fulton | Psychologist | 321 Fulton, Grand Haven, MI 49417 | 2011-09-20 |
| Find all providers in zip 49417 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548619943 | Kevin Andrew Smalley | Family Medicine | 1310 Wisconsin St Ste 103, Grand Haven, MI 49417-2472 | 2016-06-07 |
| 1184080806 | Daniel J. Graham, D.o., P.C. | Family Medicine | 925 S Beechtree St, Suite 1a, Grand Haven, MI 49417-2387 | 2016-01-11 |
| 1508120122 | Jonathan Stewart Rouwhorst | Family Medicine | 15161 Willowwood Ct, Grand Haven, MI 49417 | 2012-06-28 |
| 1508033283 | Michigan Medical Patient Care | Family Medicine | 302 S Beechtree St, Grand Haven, MI 49417-2004 | 2008-05-13 |
| 1811961899 | Donald Ezra Rutherford | Family Medicine | 1159 S Harbor Dr, Suite C4, Grand Haven, MI 49417-1796 | 2006-02-15 |
| 1457321119 | James Arthur Postema | Family Medicine | 1310 Wisconsin Street Suite 301, North Ottawa Family Practice, Grand Haven, MI 49417 | 2006-01-25 |
| 1154322113 | William H Dukes | Family Medicine | 1091 S Beacon Blvd, Grand Haven, MI 49417-2607 | 2005-08-02 |
| 1003811092 | Lee Michael Sterenberg | Family Medicine | 600 Park Ave, Grand Haven, MI 49417-2173 | 2005-06-16 |
| 1386648624 | David Thomas Ottenbaker | Family Medicine | 1445 Sheldon Rd, Suite 201, Grand Haven, MI 49417-2480 | 2005-06-01 |
| 1134121270 | Larry A Poel | Family Medicine | 1310 Wisconsin Ave, Suite 301, Grand Haven, MI 49417-2472 | 2005-06-01 |
| Find all providers in GRAND HAVEN | ||||
| City | GRAND HAVEN |
| Zip Code | 49417 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.