Individual
MR. BRENT CHARLES RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
43145 SCHOENHERR RD, STERLING HEIGHTS, MI 48313-1955
(589) 997-5048
(589) 997-5049
Mailing address
12685 HIGHLAND RD, HARTLAND, MI 48353-2933
(419) 865-4448
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50-00-0863
OH
363AM0700X
Medical Physician Assistant
5601002647
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55.000448
CERTIFICATE TO PRESCRIBE
OH
01
—
5601002647
PAIN MANAGEMENT
MI
Enumeration date
10/17/2006
Last updated
03/07/2023
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