MEDICARE: DR. JOSEPH C RUSSELL MD

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	202K00000X	Phlebology Physician	35-036708	OH
2	207R00000X	Internal Medicine Physician	35-036708	OH

General Provider Information

NPI Number	:	1720027410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH C RUSSELL MD

Provider Business Mailing Address
First Line	:	PO BOX 634984
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-891-2813
Fax Number	:	513-793-1032

Provider Business Practice Location Address
First Line	:	7794 5 MILE RD
Second Line	:	STE 270
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2368
Country	:	US
Telephone Number	:	513-624-7900
Fax Number	:	513-624-0401

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/18/2017

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