Healthcare Provider Details

I. General information

NPI: 1326052382
Provider Name (Legal Business Name): RUSSEAU TEAM HEALTHCARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S NAPERVILLE RD SUITE C
WHEATON IL
60187-5473
US

IV. Provider business mailing address

311 S NAPERVILLE RD SUITE C
WHEATON IL
60187-5473
US

V. Phone/Fax

Practice location:
  • Phone: 630-690-4040
  • Fax:
Mailing address:
  • Phone: 630-690-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN J RUSSEAU
Title or Position: PRESIDENT
Credential: DC, DIBCN, DABFP
Phone: 630-690-4040