Individual
JONATHAN MICHAEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
705 OAK ST UNIT 11, BIG RAPIDS, MI 49307-3108
(231) 592-1002
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007115
MI
Other
Enumeration date
08/22/2014
Last updated
02/23/2021
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