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MARK W RUSSELL MD NPI 1083620256


NPI Information

NPI: 1083620256
Provider Name: MARK W RUSSELL, MD
Classification: Pediatrics - 2080P0202X
Entity Type: Individual

Specialization: Pediatric Cardiology

PECOS Registration: Yes

Address:
1500 E MEDICAL CENTER DR
11TH FLOOR CS MOTT CHILDRENS HOSPITAL ROOM 661
ANN ARBOR, MI
ZIP 48109
Phone: (734) 764-5176
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Mark W Russell, MD is a pediatric cardiology pediatrics in Ann Arbor, MI with 35 years of experience. The provider is a pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. Mark W Russell, MD NPI is 1083620256. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: DUKE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1989

The provider's business location address is:

1500 E MEDICAL CENTER DR
11TH FLOOR CS MOTT CHILDRENS HOSPITAL ROOM 661
ANN ARBOR, MI
ZIP 48109-204
Phone: (734) 764-5176

The NPI 1083620256 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/31/2006 and was last updated on 4/29/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics4301060392MICHIGANNo
22080P0202XPediatricsPediatric Cardiology4301060392MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13226763MEDICAIDMICHIGAN
2G21345MEDICARE UPIN
30H16103208MEDICARE ID-TYPE UNSPECIFIEDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.