Provider Demographics
NPI:1033442231
Name:RUSSO, CHRISTOPHER ROSS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROSS
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:710 KENMOOR AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2379
Mailing Address - Country:US
Mailing Address - Phone:616-588-7246
Mailing Address - Fax:616-588-7086
Practice Address - Street 1:710 KENMOOR AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2379
Practice Address - Country:US
Practice Address - Phone:616-588-7246
Practice Address - Fax:616-588-7086
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2012-04-12
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Provider Licenses
StateLicense IDTaxonomies
MI4301064161207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine