Individual
DR. MARK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
2155 DOGWOOD DR APT 263, LISLE, IL 60532-1789
(630) 489-8877
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
Primary
036.159014
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2018
Last updated
06/02/2022
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