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Individual

MR. DALE EVERETTE RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4200 WHITEHALL DR STE 150, ANN ARBOR, MI 48105-9694
(734) 995-0308
Mailing address
24 FRANK LLOYD WRIGHT DR STE J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002145
MI

Other

Enumeration date
05/06/2008
Last updated
01/14/2020
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