Individual
SANDRA K RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2104 JOLLY RD, SUITE 220, OKEMOS, MI 48864-6043
(517) 975-1400
(517) 975-1405
Mailing address
401 S BALLENGER HWY, FLINT, MI 48532-3638
(810) 342-1000
(810) 342-1590
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101010708
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700083
PHYSICIANS HEALTH PLAN
MI
01
—
1006244
MCLAREN HEALTH PLAN
MI
01
—
160C311260
BLUE CHOICE
MI
01
—
1652300205
BLUE CROSS BLUE SHIELD
MI
05
—
4460493
—
MI
01
—
E68082
HEALTH NET FEDERAL SERVIC
MI
Enumeration date
01/20/2006
Last updated
11/29/2012
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