Russell, Brent Charles

Russell, Brent Charles is an sole proprietor health care provider with primary practice located at 43145 Schoenherr Rd , Sterling Heights MI 48313-1955. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Russell, Brent Charles can be contacted via phone (589) 997-5048.

Contact Information

Primary practice address
43145 Schoenherr Rd Sterling Heights MI 48313-1955
Phone: (589) 997-5048
Fax: (589) 997-5049
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 5601002647 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 50-00-0863 Ohio

Profile Details

NPI number 1255412318
LBN Legal business name Russell, Brent Charles
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 17th, 2006
Last updated Mar 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255412318 NPPES
Ohio Other 55.000448 CERTIFICATE TO PRESCRIBE
Ohio Other 5601002647 CERTIFICATE TO PRESCRIBE

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