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General NPI Number Information
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NPI Number | 1841425022
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Entity Type | Organization
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Legal Business Name | COLDWATER CROSSING INTERNAL MEDICINE, PLLC.
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 327 W CHICAGO ST
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City | COLDWATER
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State | MI
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Zip | 49036-2805
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Country | US
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Telephone | 517-278-8000
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Fax | 517-278-8007
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Provider Business Mailing Address
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Address Line | 327 W CHICAGO ST
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City | COLDWATER
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State | MI
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Zip | 49036-2805
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Country | US
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Telephone | 517-278-8000
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Fax | 517-278-8007
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY RUSSELL
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Credential | D.O.
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Telephone | 517-278-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401009358
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101011799
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License Number State | MI
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