Individual
ALLEN J RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
32401 8 MILE RD, LIVONIA, MI 48152-1301
(913) 359-6001
(913) 359-5552
Mailing address
6601 COLLEGE BLVD STE 120, OVERLAND PARK, KS 66211-1504
(913) 359-6001
(217) 897-6999
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
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