Individual
EVAN T RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2325 18TH ST, SUITE 130, COLUMBUS, IN 47201-5388
(812) 379-2020
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
01068153A
IN
208M00000X
Hospitalist Physician
01068153A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201012920
—
IN
Enumeration date
07/08/2008
Last updated
09/06/2024
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