Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michael Jonathan Russo, STUDENT

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1558822510

Michael Jonathan Russo, STUDENT is a Family Practice in Chicago, Illinois. Qualified in 2019, 7 years ago. Practices with Memorial Physician Services, a 158-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

4025 N Western Ave Bldg E
Chicago, IL 60618-3726
Phone: (773) 275-7700
Fax: (773) 279-6504
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 836 W Wellington Ave, Chicago, IL 60657-5147 — (773) 975-1600

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 036.158890 (IL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1558822510
Entity typeIndividual (Type 1)
GenderMale
Credentials STUDENT
Sole proprietorNo
NPI enumeratedMarch 30, 2019
Last updated in NPPESAugust 23, 2022
Certification dateJanuary 7, 2021
Mailing address29373 Network Pl, Chicago, IL 60673-1293

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Memorial Physician Services — 158 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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