Individual
ALLEN J RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301042036
MI
208D00000X
General Practice Physician
4301042036
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301042036
STATE LICENSE
MI
Enumeration date
05/24/2005
Last updated
11/09/2023
Update your record
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