Organization
ELKHART NEUROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK W RUSSELL DO (PRESIDENT)
(574) 522-7624
Entity
Organization
Contact information
Practice address
2746 OLD US 20 W, SUITE A, ELKHART, IN 46514-1364
(574) 522-7624
(574) 522-9405
Mailing address
2746 OLD US 20 W, SUITE A, ELKHART, IN 46514-1364
(574) 522-7624
(574) 522-9405
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
02001219
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114080B
—
IN
Enumeration date
03/06/2007
Last updated
05/05/2008
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