Individual
DR. STEPHANIE JANE RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
200 ENTERPRISE DR STE A, PENDLETON, IN 46064-9038
(765) 298-4567
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(765) 298-4569
(765) 298-4568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11014474A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200975760
—
IN
01
—
P01430098
RAILROAD MEDICARE
IN
Enumeration date
06/25/2008
Last updated
10/09/2025
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