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Organization
GRAND OLD DOCS OF THE SOUTHSIDE
Active
Organization
GRAND OLD DOCS OF THE SOUTHSIDE
Active
Other names
Central Indiana Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA R RUSSELL MD (PHYSICIAN)
(317) 865-9090
Entity
Organization
Contact information
Practice address
360 S MADISON AVE, #200, GREENWOOD, IN 46142-3150
(317) 865-9090
(317) 865-0523
Mailing address
1350 E COUNTY LINE RD, SUITE I, INDIANAPOLIS, IN 46227-0873
(317) 865-9090
(317) 865-0523
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/25/2006
Last updated
06/30/2008
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