Individual
ALEXANDER S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202
(313) 874-4696
(313) 874-4677
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 874-4696
(313) 874-4677
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
50.005155RX
OH
363A00000X
Physician Assistant
Primary
5601008724
MI
Other
Enumeration date
07/28/2017
Last updated
07/25/2018
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