Individual
COREY B RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3055 W SYLVANIA AVE, TOLEDO, OH 43613-4135
(419) 473-0125
(419) 473-1230
Mailing address
3055 W SYLVANIA AVE, TOLEDO, OH 43613-4135
(419) 473-0125
(419) 473-1230
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36002914
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2071109
—
OH
Enumeration date
04/26/2006
Last updated
03/21/2016
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