Individual
RUSSELL LLOYD AVELLANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 E HURON ST, SUITE 1-200, CHICAGO, IL 60611-2909
(312) 503-1851
Mailing address
240 E HURON ST, SUITE 1-200, CHICAGO, IL 60611-2909
(312) 503-1851
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60672295
WA
Other
Enumeration date
04/08/2015
Last updated
09/06/2016
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