MEDICARE: ALEXIS RUSSELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1093670820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS RUSSELL

Provider Business Mailing Address
First Line	:	4868 MONTICELLO BLVD
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-2846
Country	:	US
Telephone Number	:	216-394-8451
Fax Number	:

Provider Business Practice Location Address
First Line	:	4868 MONTICELLO BLVD
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-2846
Country	:	US
Telephone Number	:	216-394-8451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ ALEXIS RUSSELL ” Practice Location

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