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NPI Code Detail

MEDICARE: RUSSELL W. NORWOOD MD

MEDICARE: RUSSELL W. NORWOOD MD
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
12085R0202XDiagnostic Radiology PhysicianR11145MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00928212OTHERKYRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000690225OTHERKYBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518935022
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL W. NORWOOD MD
Provider Business Mailing Address
First Line : 3300 BURR OAK AVE
Second Line : 2ND FLOOR
City : BLUE ISLAND
State : IL
Zip : 60406-3802
Country : US
Telephone Number : 708-388-0423
Fax Number : 708-388-1477
Provider Business Practice Location Address
First Line : 12935 GREGORY ST
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2428
Country : US
Telephone Number : 708-385-4433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 07/27/2011

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Directions to “ RUSSELL W. NORWOOD MD” Practice Location

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