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General NPI Number Information
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NPI Number | 1275526667
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Entity Type | Individual
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Provider Name | RUSSELL STEVEN YALE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 10520 N. PORT WASHINGTON RD.
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City | MEQUON
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State | WI
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Zip | 53092
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Country | US
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Telephone | 262-240-0705
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Fax | 262-240-0759
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Provider Business Mailing Address
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Address Line | 100-15TH AVE. #180
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-1160
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Country | US
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Telephone | 414-744-6589
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Fax | 414-764-4307
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 22241-20
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License Number State | WI
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