Individual
BRENDA R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8920 SOUTHPOINTE DR, SUITE B, INDIANAPOLIS, IN 46227-7509
(317) 497-1900
(317) 497-1919
Mailing address
6626 E. 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01034924A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080132420
RAILROAD MEDICARE #
IN
Enumeration date
02/15/2006
Last updated
03/09/2015
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