Individual
MICHAEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1620 W HARRISON ST, CHICAGO, IL 60612-3801
(815) 531-7382
Mailing address
25408 S MALLARD DR, CHANNAHON, IL 60410-9710
(815) 531-7382
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.480622
IL
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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