Healthcare Provider Details

I. General information

NPI: 1235115460
Provider Name (Legal Business Name): COUNTY OF GENESEE OFFICE OF CONTROLLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503
US

IV. Provider business mailing address

420 W 5TH AVE
FLINT MI
48503
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3736
  • Fax: 810-257-3785
Mailing address:
  • Phone: 810-257-3736
  • Fax: 810-257-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME0100974
License Number StateMI

VIII. Authorized Official

Name: MR. DANIS RUSSELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 810-257-3707