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General NPI Number Information
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NPI Number | 1013756352
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Entity Type | Individual
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Provider Name | RYLIE RUSS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 3290 W BIG BEAVER RD STE 150
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City | TROY
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State | MI
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Zip | 48084-2931
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Country | US
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Telephone | 248-792-6257
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Fax | 248-792-9106
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Provider Business Mailing Address
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Address Line | 3290 W BIG BEAVER RD STE 150
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City | TROY
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State | MI
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Zip | 48084-2931
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Country | US
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Telephone | 734-536-5938
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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