Doctor Name: | MR. RICHARD RUSSELL |
NPI Number: | 1891117818 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 5000 W National Ave Milwaukee, WI - 532950001 |
Business Phone Number: | 4143842000 |
Business Fax Number: | |
Mailing Address: | 4475 W Dean Rd, Apt. 103 BROWN DEER |
State: | WI |
Postal Code: | 532233182 |
Phone Number: | 4143842000 |
Fax Number: | 4149025468 |
NPI Enumeration Date: | 01/10/2014 |
NPI Last Update Date: | 01/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |