Provider Demographics
NPI:1295118784
Name:RUSINOW, WILLIAM DANIEL II (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:RUSINOW
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24911 LITTLE MACK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3200
Mailing Address - Country:US
Mailing Address - Phone:586-777-2050
Mailing Address - Fax:
Practice Address - Street 1:97 MONROE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2855
Practice Address - Country:US
Practice Address - Phone:313-965-3365
Practice Address - Fax:313-965-3622
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2018-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301107064390200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program