Provider Demographics
NPI:1104202076
Name:RUSIN, KATERYNA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATERYNA
Middle Name:
Last Name:RUSIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7975 MATERA CT
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2157
Mailing Address - Country:US
Mailing Address - Phone:646-707-2688
Mailing Address - Fax:
Practice Address - Street 1:14616 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8413
Practice Address - Country:US
Practice Address - Phone:941-909-7755
Practice Address - Fax:941-213-6958
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134666207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100000600Medicaid