DR. MARK RUSSELL (NPI# 1154827756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154827756 |
| Entity Type | Individual |
| Full Name | DR. MARK RUSSELL |
| Credential | MD |
| Practice Address |
2160 S 1st Ave Maywood IL 60153-3328 |
| Mailing Address |
2155 Dogwood Dr Apt 263 Lisle IL 60532-1789 |
| Practice Telephone | 7082169000 |
| Mailing Telephone | 6304898877 |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-04-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831710771 | Mark William Russell | Dentist | 461 Western Blvd Ste 104, Jacksonville, NC 28546-7637 | 2020-05-01 |
| 1144752221 | Mark Russell | Social Worker | 475 Sykesville Troutville Rd, Punxsutawney, PA 15767-4367 | 2017-03-29 |
| 1154767267 | Mark Stephen Russell Jr. | Counselor | 3901 Airport Fwy Ste 107, Bedford, TX 76021-6117 | 2013-05-15 |
| 1437314366 | Mark William Russell | Community Health Worker | 108 Schooner Landing Dr, Edenton, NC 27932-8833 | 2008-07-21 |
| 1306867049 | Mark Duane Russell | Specialist/Technologist | 3950 Hollywood Rd Ste 140, Saint Joseph, MI 49085-9151 | 2006-07-21 |
| 1639137540 | Mark Russell | Internal Medicine | 13024 Hesperia Rd Ste 103, Victorville, CA 92395-8303 | 2006-05-02 |
| 1689671315 | Mark Dale Russell | Chiropractor | 5309 44th St, Lubbock, TX 79414-1321 | 2005-07-07 |
| 1033654967 | Mark Russell | Pharmacist | 2920 Knoxville Center Dr, Knoxville, TN 37924-2013 | 2017-01-02 |
| 1477097392 | Mark Russell | Social Worker | 302 S Spring St, Tupelo, MS 38804-4853 | 2016-12-12 |
| 1134463870 | Mark Joseph Russell | Occupational Therapist | 275 East Main Street, Frankfort, KY 40621-0001 | 2012-11-19 |
| Street Address |
2160 S 1ST AVE |
| City | MAYWOOD |
| State | IL |
| Zip Code | 60153-3328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174525489 | Michael Jm Raffin | Audiologist | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2005-06-01 |
| 1366049900 | Kenneth Bernard Jordan | Psychiatry & Neurology | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-10-06 |
| 1124634712 | Abhilasha Nitin Borkar | Pathology | 2160 S 1st Ave, Maywood, IL 60153 | 2020-09-18 |
| 1306450325 | Linda Ippolito | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-09-08 |
| 1194339135 | Meghan Henry | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-09-08 |
| 1194339911 | Victoria Leah Drozd | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-31 |
| 1396357588 | Madison Schaefer | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-19 |
| 1134731375 | Otanthia S Williams-brady | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-19 |
| 1205454287 | Janet Nickels | Audiologist | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-07-07 |
| 1417574054 | Kathryn Clemans | Nurse Anesthetist, Certified Registered | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053933077 | Judie Noemie Hoilat | Internal Medicine | 2160 S 1st Avenue, Maywood, IL 60153 | 2020-05-13 |
| 1457972457 | Yuchen Zheng | Student in an Organized Health Care Education/Training Program | Department of Neurology, Loyola University Medical Cent, 2160 S. First Ave, Maywood, IL 60153 | 2020-04-30 |
| 1437779519 | Amna Amad Siddiqui | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue, Loyola University Medical Center, Maywood, IL 60153 | 2020-04-20 |
| 1982232211 | Brian Kurtz | Student in an Organized Health Care Education/Training Program | 2160 S First Ave, Bulding 105-suite 2840a, Maywood, IL 60153 | 2020-03-31 |
| 1902434947 | Saadiya Jabbar | Psychiatry & Neurology | Loyola University Medical Center, Building 105, Suite 1940, Maywood, IL 60153 | 2020-03-27 |
| 1558919472 | Linda Sue Moton | Technician | 10 South 15 Apt. 1, Maywood, IL 60153 | 2019-09-04 |
| 1760047518 | Braden Robert Dasovic | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue Building 105/room 2700, Department, Loyola Medical Center, Maywood, IL 60153 | 2019-05-07 |
| 1134680713 | Madeline Shaoyun Tiee | Orthopaedic Surgery | Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 | 2019-03-27 |
| 1538629746 | Michael Murphy | Orthopaedic Surgery | 2160 S 1st Ave., Maguire Center, Dept of Ortho Surg, Maywood, IL 60153 | 2019-03-22 |
| 1053871681 | Michael V Padua | Psychiatry & Neurology | 2160 S 1st Ave Bldg, Maywood, IL 60153 | 2019-03-20 |
| Find all providers in zip 60153 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457972457 | Yuchen Zheng | Student in an Organized Health Care Education/Training Program | Department of Neurology, Loyola University Medical Cent, 2160 S. First Ave, Maywood, IL 60153 | 2020-04-30 |
| 1437779519 | Amna Amad Siddiqui | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue, Loyola University Medical Center, Maywood, IL 60153 | 2020-04-20 |
| 1982232211 | Brian Kurtz | Student in an Organized Health Care Education/Training Program | 2160 S First Ave, Bulding 105-suite 2840a, Maywood, IL 60153 | 2020-03-31 |
| 1013540244 | Lisa Laurenzana | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave Bldg Stritch, Maywood, IL 60153-3328 | 2020-02-17 |
| 1972149649 | Jenna Gartz | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave Rm 4500, Maywood, IL 60153-3328 | 2019-11-18 |
| 1760047518 | Braden Robert Dasovic | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue Building 105/room 2700, Department, Loyola Medical Center, Maywood, IL 60153 | 2019-05-07 |
| 1538626718 | Tyana Davis | Student in an Organized Health Care Education/Training Program | 624 S 21st Ave, Maywood, IL 60153-1476 | 2019-02-25 |
| 1801391438 | Giacomo Colver Waller | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave Ste 2840, Maywood, IL 60153-3328 | 2018-03-26 |
| 1194339911 | Victoria Leah Drozd | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-31 |
| 1467073668 | Isabel Anne Pennings | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-04-29 |
| Find all providers in MAYWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.