Individual
RUSS CARL KOLARIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 695-6697
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
30751
SC
208000000X
Pediatrics Physician
Primary
30751
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307518
—
SC
01
—
P00682405
RR MEDICARE
SC
Enumeration date
02/14/2006
Last updated
04/26/2024
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