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Individual

JOSEPH RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
24020 W RIVERWALK CT STE 102, PLAINFIELD, IL 60544-7107
(815) 676-2528
(815) 676-2586
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036064556
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036064556
IL
Enumeration date
03/09/2006
Last updated
08/18/2023
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