Individual
MS. MICHELLE M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7700 WASHINGTON VILLAGE DR STE 210, CENTERVILLE, OH 45459-4094
(937) 562-2291
(937) 562-2293
Mailing address
7700 WASHINGTON VILLAGE DR STE 210, CENTERVILLE, OH 45459-4094
(937) 562-2291
(937) 562-2293
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34005033
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000227882
ANTHEM
OH
01
—
0120237
UNITED HEALTH CARE
OH
01
—
080191704
RAILROAD MEDICARE
OH
05
—
0887394
—
OH
01
—
34005033R
MEDICAL LICENSE
—
01
—
421534506073
CARESOURCE
OH
01
—
590581
AETNA
OH
01
—
D0503304
HUMANA/CHOICECARE
OH
01
—
OC06218
NATIONWIDE
OH
Enumeration date
12/20/2005
Last updated
11/24/2020
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