Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 35074626 | OH |
NPI | 1043219496 |
---|---|
Provider Name | Todd E Russell |
First Address | Toledo, OH 43606-3856 |
Second Address | Toledo, OH 43606-3856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000493404 | ANTHEM (01) | OH |
03444 | PARAMOUNT (01) | OH |
10221 | HEALTH PLAN OF MI (01) | OH |
21-01841 | UHC (01) | OH |
2215678 | (05) | OH |
4957870 | (05) | MI |
5773778 | AETNA (01) | OH |
G94647 | (02) | OH |
P00366278 | RRMC (01) | OH |