Individual
TIMOTHY J. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
17495 LA GRANGE RD, TINLEY PARK, IL 60487-7581
(708) 406-3243
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-0685741
IL
Other
Enumeration date
07/31/2006
Last updated
06/15/2022
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