Russell, Evan T

Russell, Evan T is an individual health care provider with primary practice located at 2325 18Th St Suite 130, Columbus IN 47201-5388. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Russell, Evan T can be contacted via phone (812) 379-2020.

Contact Information

Primary practice address
2325 18Th St Suite 130 Columbus IN 47201-5388
Phone: (812) 379-2020
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 01068153A Indiana
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 01068153A Indiana

Profile Details

NPI number 1609039973
LBN Legal business name Russell, Evan T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2008
Last updated Oct 31st, 2022 - 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 1609039973 NPPES
Indiana MEDICAID 201012920

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