Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038-007072 | IL |
NPI | 1508870080 |
---|---|
Provider Name | Dr. Kevin J Russeau |
First Address | Wheaton, IL 60187-5473 |
Second Address | Wheaton, IL 60187-5473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022-22298 | BC/BS (01) | IL |
4655917 | AETNA (01) | |
79863 | HEALTH PARTNERS (01) | |
8228039001 | CIGNA (01) | |
U34539 | (02) | IL |