Provider Demographics
NPI:1164615936
Name:RUSILKO, PAUL J (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:RUSILKO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1350 LOCUST STREET
Mailing Address - Street 2:SUITE G100A
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219
Mailing Address - Country:US
Mailing Address - Phone:412-232-5850
Mailing Address - Fax:412-232-5940
Practice Address - Street 1:1350 LOCUST STREET
Practice Address - Street 2:SUITE G100A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219
Practice Address - Country:US
Practice Address - Phone:412-232-5850
Practice Address - Fax:412-232-5940
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2021-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019644208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164615936Medicaid
MI1164615936Medicaid