Individual
DR. PATRICK W RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
615 N MICHIGAN ST, 1ST FL HOSPITALIST STE, SOUTH BEND, IN 46601-1033
(574) 647-3050
(574) 647-1094
Mailing address
1219 GREENLEAF BLVD, ELKHART, IN 46514-1365
(574) 536-4753
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
02001219
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215919
BLUE SHIELD
IN
05
—
100114080
—
IN
01
—
130024231
MEDICARE RAILROAD
IN
Enumeration date
12/13/2005
Last updated
05/19/2023
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