Individual
RUSSELL EIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3300 OAKDALE AVE N, MINNEAPOLIS, MN 55422-2926
(763) 520-5200
Mailing address
2986 S SUPERIOR ST, MILWAUKEE, WI 53207-2544
(715) 308-4563
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1164184
—
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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