MEDICARE: RYAN LEE RUSSELL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	14275325-1204	UT

General Provider Information

NPI Number	:	1457000523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LEE RUSSELL DO

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 METROHEALTH DRIVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1998
Country	:	US
Telephone Number	:	216-778-4486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2022
Last Update Date	:	05/04/2026

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