Individual
THOMAS JOSEPH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13800 W NORTH AVE, STE 100, BROOKFIELD, WI 53005-4974
(262) 754-4488
(262) 754-4940
Mailing address
13800 W NORTH AVE, STE 100, BROOKFIELD, WI 53005-4974
(262) 754-4488
(262) 754-4940
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
15093020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30899900
—
WI
Enumeration date
08/30/2005
Last updated
04/20/2008
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