Provider Demographics
NPI:1164799631
Name:RUSSELL CIUFO MD LLC
Entity Type:Organization
Organization Name:RUSSELL CIUFO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TAX ID OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIUFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-279-2402
Mailing Address - Street 1:10455 FRANKS RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5219
Mailing Address - Country:US
Mailing Address - Phone:440-537-2734
Mailing Address - Fax:
Practice Address - Street 1:10455 FRANKS RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-5219
Practice Address - Country:US
Practice Address - Phone:440-537-2734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4018376OtherMEDICARE