Russell, Patrick W
Russell, Patrick W is an sole proprietor health care provider with primary practice located at 615 N Michigan St 1St Fl Hospitalist Ste, South Bend IN 46601-1033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Russell, Patrick W can be contacted via phone (574) 647-3050.Contact Information
Primary practice address
615 N Michigan St 1St Fl Hospitalist Ste
South Bend IN 46601-1033
Phone: (574) 647-3050
Fax: (574) 647-1094
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 02001219 | Indiana |
Profile Details
| NPI number | 1144205113 |
|---|---|
| LBN Legal business name | Russell, Patrick W |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 13th, 2005 |
| Last updated | May 19th, 2023 - about last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144205113 | NPPES |
| Indiana | Other | 000000215919 | BLUE SHIELD |
| Indiana | MEDICAID | 100114080 | BLUE SHIELD |
| Indiana | Other | 130024231 | BLUE SHIELD |
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