Patricia A Russo, D.P.M.
Individual provider Active NPI Podiatrist · Melbourne, IA
NPI 1609201227 · NPPES record last updated Sep 13, 2013
Key facts
- NPI
- 1609201227
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 00749 (IA)
- Practice address
- 2958 Ingram Ave
Melbourne, IA 50162-9559 - Phone
- (641) 750-7185
- NPI assigned
- Sep 13, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00749 | IA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iowa Podiatry Care, Inc. | Podiatrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 00749 | IA | Yes |
Addresses
Primary practice location
2958 Ingram Ave
Melbourne, IA 50162-9559
Mailing address
2958 Ingram Ave
Melbourne, IA 50162-9559
Phone (641) 750-7185
Other providers in Melbourne, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.