Organization
RUSSEAU TEAM HEALTHCARE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN J RUSSEAU DC, DIBCN, DABFP (PRESIDENT)
(630) 690-4040
Entity
Organization
Contact information
Practice address
311 S NAPERVILLE RD, SUITE C, WHEATON, IL 60187-5473
(630) 690-4040
Mailing address
311 S NAPERVILLE RD, SUITE C, WHEATON, IL 60187-5473
(630) 690-4040
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
539590
PTAN
IL
Enumeration date
07/27/2006
Last updated
04/17/2009
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