Individual
JAMES PATRICK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13800 W NORTH AVE, STE 100, BROOKFIELD, WI 53005-4974
(262) 754-4488
(262) 754-4940
Mailing address
13800 W NORTH AVE, STE 100, BROOKFIELD, WI 53005-4974
(262) 754-4488
(262) 754-4940
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
47855020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34688800
—
WI
01
—
P00364352
RAILROAD MEDICARE
WI
01
—
P00368881
RAILROAD MEDICARE
WI
01
—
P00384061
RAILROAD MEDICARE
WI
Enumeration date
08/30/2005
Last updated
04/20/2008
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