Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301079386 | MI |
N | 2086S0120X | Pediatric Surgery | 35088248 | OH |
NPI | 1356429658 |
---|---|
Provider Name | Dr. Russell A. Faust |
First Address | Pontiac, MI 48341-0432 |
Second Address | Pontiac, MI 48341-0432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 28/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G03779 | (02) |