Healthcare Provider Details

I. General information

NPI: 1750290805
Provider Name (Legal Business Name): SARAH J RUSSE DBE, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N. ST CLAIR STREET SUITE 1785B
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-2578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: