Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 23780 | ZZ |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35.136534 | OH |
N | 207VG0400X | Gynecologist | 35.136534 | OH |
NPI | 1538423967 |
---|---|
Provider Name | Miguel A Luna Russo |
First Address | Cleveland, OH 44195-6309 |
Second Address | Cleveland, OH 44195-6309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 09/08/2021 |