Individual
DR. LISA M RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608-1732
(773) 257-6468
Mailing address
3537 PAYSPHERE CIR, CHICAGO, IL 60674-0035
(708) 786-2900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
IL
207RI0200X
Infectious Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-095012-2
—
IL
Enumeration date
10/12/2005
Last updated
09/11/2025
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