Individual
MR. RUSS MICHAEL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBA
Contact information
Practice address
2501 W 22ND ST, SIOUX FALLS, SD 57105-1305
(605) 336-3230
Mailing address
2501 W 22ND ST, SIOUX FALLS, SD 57105-1305
(605) 336-3230
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101Y00000X
COUNSELOR
—
Enumeration date
06/30/2011
Last updated
06/30/2011
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