| Doctor Name: | DR. KATHY J RUSSETH |
| NPI Number: | 1275692030 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 49950-020 |
| Business Practice Address: | 11101 W Lincoln Ave Milwaukee, WI - 532271133 |
| Business Phone Number: | 4142034539 |
| Business Fax Number: | 4143283708 |
| Mailing Address: | 11101 W Lincoln Ave, MILWAUKEE |
| State: | WI |
| Postal Code: | 532271133 |
| Phone Number: | 4142034539 |
| Fax Number: | 4143283708 |
| NPI Enumeration Date: | 12/07/2006 |
| NPI Last Update Date: | 07/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 49950-020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |